Douglas DiRuggiero, DMSc, MHS, PA-C

Addressing Biologic Dosing and Adherence With Patients

Video content above is prompted by the following:

How important is patient adherence to biologic therapies for atopic dermatitis? How do you talk to your patients about treatment adherence?

What recommendations do you offer to your patients to help them remember to give themselves injections?

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Panelists discuss how adherence to biologic therapy is fundamental to achieving optimal outcomes in atopic dermatitis, with consistent administration essential for maintaining therapeutic levels and preventing disease rebound. Also vital are clear communication about injection schedules, development of practical reminder systems (calendar alerts, smartphone apps, medication journals), consideration of dosing frequency preferences, involvement of supportive family members, incorporation into existing routines, the addressing of injection anxiety through proper training and technique refinement, and regular follow-up to troubleshoot barriers—all while emphasizing the connection between adherence and sustained disease control to maintain patient motivation through the treatment journey.

Patient Considerations to Guide Biologic Treatment Selection in Atopic Dermatitis

What patient factors do you take into consideration when prescribing a biologic for atopic dermatitis?

How does a patient’s age or weight impact their biologic treatment options?

Dupilumab is approved for patients 6 months or older.

Lebrikizumab, tralokinumab, and nemolizumab are approved for patients 12 years or older.

Does your approach to treatment selection differ if the patient is biologic-naive vs if the patient has tried a biologic in the past?

Panelists discuss how selecting a biologic for atopic dermatitis involves comprehensive assessment of patient-specific factors including age (with dupilumab's broader approval for patients as young as 6 months vs other biologics approved only for those aged 12 years or older), weight (affecting dosing considerations), disease phenotype, symptom predominance (especially itch severity for nemolizumab consideration), comorbidities (including asthma, food allergies, and ocular conditions), prior treatment responses, insurance coverage, administration preferences, anticipated adherence, treatment goals, and previous biologic experience—with biologic-naive patients typically receiving broader consideration, whereas those with prior biologic exposure require careful evaluation of previous response patterns, reasons for discontinuation, and strategic selection of agents with different mechanisms to potentially overcome therapeutic plateaus.

Safety of Biologics in Atopic Dermatitis Treatment

What are some of the most common adverse effects that you see with biologics in clinical practice?

How do you discuss the efficacy and safety of biologics for atopic dermatitis with your patients and their families?

How do you set treatment expectations with your patients, and how do you monitor for safety and effectiveness of treatment with biologics?

Panelists discuss how biologics for atopic dermatitis demonstrate excellent safety profiles with primarily mild, manageable adverse effects such as injection site reactions, conjunctivitis (particularly with dupilumab), mild infections, and headaches. However, they note that successful management requires transparent discussions with patients about realistic treatment expectations (typically emphasizing gradual improvement rather than immediate resolution), systematic monitoring protocols combining objective assessments (EASI/BSA/IGA) with patient-reported outcomes (itch severity, sleep quality, quality-of-life measures), appropriate timing of evaluation intervals, laboratory monitoring when indicated, and clear communication about what constitutes a meaningful response vs the need to consider therapeutic adjustments.

Managing the Topical to Biologic Transition in Clinical Practice

How often are you using biologics as monotherapy for your patients with atopic dermatitis over continuing with topical agents?

How do you decide if you will continue a patient’s topical treatments or use a biologic as monotherapy?

How do you transition a patient from topical treatment over to biologics?

Panelists discuss how decisions regarding biologic monotherapy vs combination with topicals in atopic dermatitis management are individually tailored based on disease severity, distribution, prior topical response, treatment burden, patient preference, and insurance considerations. Most practitioners implement a gradual transition that maintains topicals during biologic initiation, tapering as systemic control improves while still reserving topicals for breakthrough flares, sensitive areas, or maintenance of partially responsive sites, ultimately aiming to minimize steroid exposure while maximizing quality of life and treatment satisfaction.

Douglas DiRuggiero, DMSc, MHS, PA-C

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