April 07, 2021
For the treatment of moderate-to-severe atopic dermatitis, biologics with the most robust efficacy and safety evidence are dupilumab, baricitinib, abrocitinib, and delgocitinib, according to a systematic review published online ahead of print in the journal Dermatology.
“As many patients are increasingly interested in biologics, and more dermatologists choose biologics as their first-line therapeutic plan, the present review will help clinicians make the recommendation to patients who are either uninterested in the conventional approach or who would like to try a biologic therapy,” wrote a research team from Beijing, China.
The systematic review included 28 randomized controlled trials, four unpublished trials, two observational studies, and one meta-analysis that spanned eight types of biologics used on- and off-label to treat atopic dermatitis: IL-4/IL-13 inhibitors, JAK inhibitors, anti-IL-13 antibodies, anti-IL-22 antibodies, anti-IL-33 antibodies, thymic stromal lymphopoietin inhibitor, OX40 antibodies, and H4R-antagonists.
The most widely used and studied biologic was dupilumab, researchers reported. A meta-analysis as well as four trials addressed its long-term use in both adults and children. In addition to dupilumab, four other IL-4/IL-13 inhibitors were investigated in randomized, phase 2 or 3 clinical trials.
The review also found strong evidence for significant therapeutic effects of six different kinds of JAK inhibitors for atopic dermatitis in phase 2 or 3 trials. Meanwhile, results from three phase 2 clinical trials of nemolizumab suggest the anti-IL-13 antibody could be another therapeutic option for moderate-to-severe atopic dermatitis.
“Although larger, well-designed, controlled studies or head-to-head studies are needed to continue testing the efficacy and safety of some of the biologics mentioned in this paper,” researchers wrote, “they will possibly become the future study direction and main force in atopic dermatitis treatment.”
Zhou S, Qi F, Gong Y, Zhang J, Zhu B. Biological Therapies for Atopic Dermatitis: A Systematic Review [published online ahead of print, 2021 Mar 18]. Dermatology. 2021;1-11. doi:10.1159/000514535