Atopic dermatitis (AD) is one of the most common inflammatory skin diseases encountered by dermatologists on a daily basis. In this session, Peter Lio, MD, and April W. Armstrong, MD, MPH, provided an overview of the role of biologics for moderate-to-severe atopic dermatitis and reviewed some clinical scenarios in which AD treatment should be elevated to biologic therapy. Atopic dermatitis places a high burden on patients and their families, with 47% to 80% of children experiencing sleep disturbances as a result of their disease. Additionally, higher rates of clinical depression, anxiety, and suicidal ideation have been seen in patients with AD compared to the general population. Because of these comorbidities, systemic treatment of AD with biologic medications is often indicated. 

Drs Lio and Armstrong reviewed the pathogenesis of atopic dermatitis, focusing on IL-4, IL-13, and IL-31 as the major cytokines that drive AD, with overexpression leading to barrier defects, inflammation, itch, and microbiome dysbiosis. Biologic treatments for AD are formulated to downregulate the signaling of these cytokines. Dupilumab binds IL-4R, inhibiting both IL-4 and IL-13, while lebrikizumab and tralokinumab bind to IL-13 specifically to inhibit signaling. Dupilumab and tralokinumab are both approved for atopic dermatitis; lebrikizumab is still under investigation. 

In Phase 3 clinical trials, dupilumab 300 mg SC every other week led to 44% to 51% of patients achieving EASI-75 at Week 16. Similar EASI-75 rates (49-51%) were seen in clinical trials for tralokinumab 300 mg SC every other week at Week 16. Dupilumab is approved for patients 6 months and older, while tralokinumab is approved for adults 18 years and older. Lebrikizumab is pending approval in patients 12 years and older. All 3 biologics were well tolerated in clinical trials. Adverse events seen in all studies include conjunctivitis, injection site reactions, upper respiratory tract infections, and nasopharyngitis.