Table 1.
Systematic comparison of the immunopathological mechanisms and treatment responses of AD and AA. Modified from (116, 121, 122).
| Comparative Parameters | AD | AA |
|---|---|---|
| Immune response patterns | Th2-type immune response, characterized by impaired epidermal barrier function | Th1-type immune response, characterized by disruption of follicular immune privilege |
| T cell infiltration | Acute phase:Th2 Chronic phase:Th17, Th22, Th1 | Core:TH1 Auxiliary:Th2, Th17,Th22 |
| Core cytokines | IL-4, IL-5, IL-13, IL-31, TSLP | IFN-γ, TNF-α, IL-2,IL-17, IL-21 |
| Microbiome characteristics | Skin:Staphylococcus aureus↑ Gut:SCFA↓ | Skin:Propionibacterium acnes↑ Gut:SCFA↓ |
| Overlapping therapeutic agents | ||
| Dupilumab (anti-IL-4) | Patients receiving 300 mg of dupilumab every two weeks achieved IGA clearance or near clearance (IGA 0/1) at 16 weeks, significantly higher than the placebo group (36-38% vs. 8-10%) | After 48 weeks of dupilumab treatment, 32.5%, 22.5% and 15% of patients achieved SALT30/SALT50/SALT75 improvement |
| JAK inhibitors | 1. Baricitinib (BREEZE-AD1 trial):In adult patients with moderate to severe AD, the EASI-75 response rate was 24.8% in the 4 mg group, 18.7% in the 2 mg group, and 8.8% in the placebo group 2. Abrocitinib (JADE MONO-1 Trial):In patients aged >12 years with moderate to severe AD, the EASI-75 response rate at week 12 was 63% in the 200 mg group, 40% in the 100 mg group, and 12% in the placebo group 3. Upadacitinib (Measure Up 1 trial):Patients aged >12 years with moderate to severe AD, 79.7% EASI-75 response rate at week 16 in the 30mg group, 69.6% in the 15mg group, and 16.3% in the placebo group | 1.Baricitinib:In the BRAVE-AA1 trial (N = 465), the percentage of patients achieving a SALT score ≤20 at week 52 was 40.9% and 21.2% in the 4mg and 2mg baricitinib groups, respectively; In the BRAVE-AA2 trial (N = 390), the percentages were 36.8% and 24.4%, respectively 2. Abrocitinib:Among patients treated with oral abrocitinib (50–200 mg/day) for at least 3 months, 46.15%, 53.85%, and 38.46% achieved a SALT score ≤20, 50% hair regrowth, and 75% hair regrowth, respectively 3. Upadacitinib:In 25 patients (15–30 mg qid), the median absolute SALT score decreased from 50 to 25 at week 12 and further to 5 at week 24 |
| Anti-OX40/OX40L | 1. Rocatinlimab: At week 16, the group receiving subcutaneous injections of 300 mg every two weeks showed a significantly greater reduction in EASI scores, at -61.1% (95% CI, -75.2% to -47.0% 2. Amlitelimab: At week 16, the average EASI score decreased significantly in the group receiving 100 mg every 4 weeks, with a reduction of -80.12% (95% CI, -95.55% to -54.60%) | 1. IMG-007 demonstrated dose-dependent sustained efficacy in a Phase 2a trial in patients with severe alopecia areata. Patients in the high-dose group experienced an average reduction of 14.3% in SALT at 24 weeks, further decreasing to 21.7% at 36 weeks (NCT06060977) 2. Amlitelimab is currently in Phase 2 clinical trials, with no data yet available (NCTO6444451) |
| Other | 1. Tralokinumab (anti-IL-13):At 16 weeks, tralokinumab 300mg every two weeks was superior to placebo in achieving IGA 0/1 (15.8% vs. 7.1% and 22.2% vs. 10.9%, respectively) and EASI-75 (25.0% vs. 12.7% and 33.2% vs. 11.4%, respectively). 2. Lebrikizumab (anti-IL-13):Lebrikizumab 250mg every two weeks demonstrated efficacy at 16 weeks, achieving IGA 0/1 (33–43%) and EASI-75 (51%−59%) compared to placebo (11–13% and 16–18%, respectively) | 1. Tofacitinib (JAK inhibitor): 58% of patients (5–10 mg bid) achieved a SALT score improvement of >50% during 4–18 months of oral treatment 2. Ruxolitinib (JAK inhibitor): Among 12 patients with moderate to severe alopecia areata, 9 achieved an average hair regrowth rate of 92% after 3–6 months of treatment |
Th, T helper cells; AD, Atopic Dermatitis; AA, Alopecia Areata; IL, Interleukin; IFN-γ, Interferon-gamma; TNF-α, Tumor Necrosis Factor-alpha; SCFA, Short-Chain Fatty Acids; OX40, Tumor Necrosis Factor Receptor Superfamily Member 4; OX40L, Tumor Necrosis Factor Superfamily Member 4 Ligand; JAK, Janus kinase; TSLP, Thymic Stromal Lymphopoietin; IGA, Investigator’s Global Assessment; SALT, Severity of Alopecia Tool; EASI, Eczema Area and Severity Index; CI, Confidence Interval.