Atopic dermatitis (AD) is a common chronic inflammatory skin disease with complex pathophysiology that includes a wide range of clinical phenotypes. It is challenging to treat due to its limited response to available therapies. However, recent advances and a better understanding of the mechanisms underlying AD have enlightened both the complexity and the systemic impact of this disorder and helped in developing a comprehensive pipeline of new compounds and caused the discovery of novel potential therapeutic targets and drug candidates for disease management. 

Along with the regulatory approval for the IL-4Ra inhibitor dupilumab, the anti-IL-13 inhibitor tralokinumab and the JAK1/2 inhibitor baricitinib in Europe, more than 70 new compounds are in the developmental stage currently. 

For systemic therapy, biologics with a slow but pathway-specific mode of action are now contending with small molecules such as JAK inhibitors (JAKi) with fast but broader activity. Although biologics may be more adjusted for long-term control and potentially disease modification in AD, JAKi furnishes rapid relief in pruritus and inflammation. However being well-tolerated, their benefit-risk ratio is a significant issue for pharmacovigilance. If used early in the natural course of the disorder, some of these products can even act as disease modifiers and could impact the atopic march and other comorbidities.

Source: Bieber T. Atopic dermatitis: an expanding therapeutic pipeline for a complex disease. Nat Rev Drug Discov. 2022;21(1):21-40.