Biologics to Treat Atopic Dermatitis: Effectiveness, Safety, and Future Directions

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases worldwide. The clinical presentation of AD is heterogeneous and is characterized by a relapsing and remitting course. Most patients suffer from mild AD while approximately 5% to 20% experience severe disease activity, which often requires systemic treatment. Before 2017, systemic treatment options were limited to broad immunosuppressants, which often had significant toxicity and limited effectiveness. Advances in understanding AD pathophysiology have led to the development of targeted biologic therapies, including dupilumab, tralokinumab, lebrikizumab, and nemolizumab. These monoclonal antibodies specifically block key pro-inflammatory cytokines involved in AD, improving disease control and symptom relief. Dupilumab, the first approved biologic, inhibits IL-4 and IL-13 signaling, while tralokinumab and lebrikizumab selectively block IL-13. Nemolizumab targets IL-31, which plays a crucial role in pruritus. This review summarizes primarily real-world data on the effectiveness and safety of these biologics, providing clinical guidance for their use and management of side effects. It also briefly discusses promising therapeutic targets currently in phase 3 trials.