Targeted biologic agents are showing considerable functions in treating atopic dermatitis (AD) in patients refractory to topical treatments. Off-label use of immunosuppressant medications remains a mainstay treatment for severe uncontrolled AD in some countries, yet novel biologic therapies have shown markedly sounder risk-benefit ratios, although fewer long-term data exist to date. 

To date, dupilumab remains the only FDA-approved drug that has shown considerable short and mid-term efficacy and safety in trials and real-life studies.

More monoclonal antibodies targeting distinct immune pathways must be developed to increase the likelihood of acquiring disease control in AD patients. Also, combination therapy like dupilumab plus another systemic immunomodulatory agent and/or phototherapy demands further investigations to prove their efficacy.

Many other novel biologic agents have also demonstrated promising results in clinical trials; like lebrikizumab, tralokinumab, nemolizumab and ISB 830 have demonstrated improvement in disease severity and multiple endpoint outcomes. When resembled other treatments, nemolizumab has shown superiority in decreasing pruritus, like dupilumab, which is within 2 days of treatment initiation, and also maintains satisfactory long-term effectiveness. Tezepelumab has failed to show statistically significant changes in primary outcome endpoints.

Future large-scale studies to investigate the efficacy of biologics as monotherapy in children with moderate-to-severe AD are needed. Also, long-term follow-up studies evaluating the safety and continuation of the efficacy of each biologic agent are essential for patients with chronic AD. To further direct treatment decisions and guidelines, network meta-analysis is also crucial to deliver the most reasonable comparative effectiveness of biologic therapies.

Source: Ratchataswan T, Banzon TM, Thyssen JP, et al. Biologics for treatment of atopic dermatitis: current status and future prospect. J Allergy Clin Immunol Pract. 2021;9(3):1053-65.