Targeted Systemic Therapies for Adults with Atopic Dermatitis: Selecting from Biologics and JAK Inhibitors

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Moderate to severe atopic dermatitis (AD) treatments have expanded beyond topical therapies.
• Biologics and Janus kinase (JAK) inhibitors offer targeted immunomodulatory approaches for refractory AD.
• Clinical trials demonstrate high efficacy and acceptable safety for these novel agents.

Purpose of the Study:

• To aid shared decision-making in selecting systemic therapies for adults with atopic dermatitis.
• To summarize and compare the efficacy, safety, and monitoring of biologics and oral JAK inhibitors.
• To provide guidance on treatment selection for special populations with atopic dermatitis.

Main Methods:

• Review of recent clinical trial data and network meta-analyses.
• Comparative analysis of efficacy and safety profiles of biologics and JAK inhibitors.
• Consideration of treatment factors including mode of delivery, cost, and speed of onset.

Main Results:

• Higher doses of abrocitinib and upadacitinib show greater efficacy than biologics in network meta-analyses.
• Among biologics, dupilumab appears more effective than tralokinumab and lebrikizumab.
• Biologics are generally perceived as safer than JAK inhibitors, though concerns for JAK inhibitors are often based on older agents.

Conclusions:

• Individualized treatment decisions for atopic dermatitis require shared decision-making between patients and physicians.
• The choice between biologics and JAK inhibitors involves balancing efficacy, safety, and patient-specific factors.
• Evidence-based recommendations are provided for using systemic therapies in special populations with atopic dermatitis.