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

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Abstract

Therapeutic options for people with moderate or severe atopic dermatitis refractory to topical therapy have rapidly expanded in recent years. These new targeted immunomodulatory agents—biologics and Janus kinase (JAK) inhibitors—have each demonstrated high levels of efficacy and acceptable safety in mostly placebo-controlled clinical trials for atopic dermatitis, but there is no universally applicable algorithm to help choose between them for a given patient. Hence, patients and physicians should utilize shared decision making, discussing efficacy, safety, mode of delivery, monitoring, costs, speed of onset, and other factors to reach individualized treatment decisions. In this review, we try to aid shared decision making by summarizing the efficacy, safety, and monitoring of biologics and oral JAK inhibitors for adults with atopic dermatitis. Network meta-analyses suggest that higher doses of abrocitinib and upadacitinib are more effective than biologics. They also show that, among biologics, dupilumab is likely more effective than tralokinumab and lebrikizumab. Biologics are generally considered safer than JAK inhibitors, although concerns about JAK inhibitors are mainly extrapolated from older generation JAK inhibitors used in higher-risk populations. We also outline evidence and considerations for choosing and using systemic immunomodulatory treatments for special populations including pregnant individuals, those with human immunodeficiency virus (HIV), hepatitis B and C, end stage kidney disease, and older adults.

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Authors and Affiliations

  1. University of California San Francisco School of Medicine, San Francisco, CA, USA

    Richard W. Kim

  2. Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada

    Megan Lam & Aaron M. Drucker

  3. Department of Dermatology, University of California San Francisco, San Francisco, CA, USA

    Katrina Abuabara

  4. Division of Epidemiology and Biostatistics, University of California, Berkeley School of Public Health, Berkeley, CA, USA

    Katrina Abuabara

  5. Department of Dermatology, Oregon Health and Science University, Portland, OR, USA

    Eric L. Simpson

  6. Department of Medicine and Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada

    Aaron M. Drucker

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Author Contributions

Megan Lam, Richard W. Kim, and Aaron M. Drucker conducted the literature search and drafted the manuscript. All authors critically revised and approved the final manuscript.

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This study did not use any primary data not available from other sources.

Conflicts of Interest

Dr. Drucker has received compensation from the British Journal of Dermatology (reviewer and section editor), American Academy of Dermatology (guidelines writer), National Eczema Association (grant reviewer), Canadian Dermatology Today (manuscript writer), and Canadian Agency for Drugs and Technologies in Health (consultant). Dr. Simpson reports personal fees from Advances in Cosmetic Medical Derm Hawaii LLC, AbbVie, Amgen, AOBiome LLC, Arcutis Biotherapeutics, Arena Pharmaceuticals, Aslan Pharma, Boehringer Ingelheim USA, Inc., Boston Consulting Group, Bristol Myers Squibb—BMS, Collective Acumen LLC (CA), CorEvitas, Dermira, Eli Lilly, Evelo Biosciences, Evidera, ExcerptaMedica, FIDE, Forte Bio RX, Galderma, GlaxoSmithKline, Incyte, Janssen, Johnson & Johnson, Kyowa Kirin Pharmaceutical Development, Leo Pharm, Medscape LLC, Merck, MauiDerm, MLG Operating, MJH holding, Pfizer, Physicians World LLC, PRImE, Regeneron, Revolutionizing Atopic Dermatitis Inc, Roivant, Sanofi-Genzyme, Trevi therapeutics, Valeant, Vindico Medical education, and WebMD. Dr. Drucker has received research grants to his institution from the National Eczema Association, Eczema Society of Canada, Canadian Dermatology Foundation, Canadian Institutes for Health Research, US National Institutes of Health, and Physicians Services Incorporated Foundation. Dr. Abuabara has received research grants to her institution from the National Eczema Association, the US National Institutes of Health, the LEO Foundation, Pfizer, and Cosmetique Internacional SNC. She has received compensation from TARGET RWE. Dr. Simpson reports grants (or serves as principal investigator role) from AbbVie, Acrotech Biopharma Inc, Amgen, Arcutis, Aslan, Castle Biosciences, CorEvitas, Dermavant, Dermira, Eli Lilly, Incyte, Kymab, Kyowa Kirin, National Jewish Health, Leo, Pfizer, Regeneron, Sanofi, and Target RWE. These potential conflicts of interest have been reviewed and managed by Oregon Health and Science University. Mr. Kim and Dr. Lam have no relevant financial or non-financial interests to disclose.

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Kim, R.W., Lam, M., Abuabara, K. et al. Targeted Systemic Therapies for Adults with Atopic Dermatitis: Selecting from Biologics and JAK Inhibitors. Am J Clin Dermatol 25, 179–193 (2024). https://doi.org/10.1007/s40257-023-00837-w

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