Atopic dermatitis (AD) is a common acquired, relapsing inflammatory skin disease. Biologics now see their role in patients with moderate-to-severe AD. 

A report summarized both label and off-label biologics on AD treatment in phase II and phase III stages, and assembled evidence on the efficacy of the most-studied biologics. 

Literature was searched to identify all documented biological therapies for AD with a focus on treatments with the highest evidence level for AD with at least one randomized clinical trial(RCT) supporting their use.

The following observations were made-

• 28 RCTs, 4 unpublished trials, 2 observational studies, and 1 meta-analysis were included. 
• Biologics as IL-4/IL-13 inhibitors, JAK inhibitors, anti-IL-13 antibodies, anti-IL-22 antibodies, anti-IL-33 antibodies, thymic stromal lymphopoietin inhibitor (TSLP), OX40 antibodies, and H4R-antagonists were included.
• Frequently used and studied biologic was found to be Dupliumab, with 1 meta-analysis and 4 trials investigating its long-term use and application in adults as well as pediatric patients. 
• Four other IL-4/IL-13 inhibitors, other than dupilumab, were all randomized, clinical trials at phase 2–3 stage. 
• Six different types of JAK inhibitors were outlined with strong evidence demonstrating their significant therapeutic effects on AD. 
• 3 phase-2 staged clinical trials for nemolizumab, an anti-IL-13 antibody, were found
• Nemolizumab was reported as an alternative therapy for moderate-to-severe AD with long-term efficiency and safety. 

Thus it was concluded that dupilumab, barcitinib, abrocitinib, and delgocitinib are the biological therapies with the strongest evidence on efficacy and long-term safety for AD treatment. 

Although the majority of the explained biologics are still at the exploratory stage, this will aid practitioners to mention to patients about suitable biological therapies and offer experimental study directions for treatment.

Source- Dermatology 2021;237:542-552. Doi: 10.1159/000514535