Melodie Young, MSN, A/GNP-C, FSDNP, DCNP 

Safety of Biologics in Atopic Dermatitis Treatment

Video content above is prompted by the following:

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?

Videos

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.

Evaluating Biologic Treatment as Monotherapy for Atopic Dermatitis

Studies of the biologics in atopic dermatitis have shown that patients are able to achieve clear or almost clear skin when using biologics as 

. What have these studies shown about the ability to maintain clear skin in the long term?

Significantly more patients achieved clear or almost clear skin (IGA 0/1) at week 16 with dupilumab compared with placebo.

By week 2, patient-reported itch scores were significantly better for patients on dupilumab than placebo.

Among IGA 0/1 responders, 50% to 70.6% of patients on dupilumab were able to maintain an IGA 0/1 at week 36 (Worm, 2019).

Significantly more patients were able to achieve clear or almost clear skin (IGA 0/1) at week 16 with lebrikizumab compared with placebo.

Approximately 10% of patients were able to achieve clear or almost clear skin at week 4.

By week 2, patient-reported itch scores were significantly better for patients on lebrikizumab than placebo in ADvocate 1.

Among IGA 0/1 responders, 74% of patients on lebrikizumab maintained an IGA 0/1 at week 52 (Blauvelt, 2023).

Significantly more patients were able to achieve clear or almost clear skin (IGA 0/1) at week 16 with tralokinumab compared with placebo.

Among IGA 0/1 responders, 39% to 59% of patients on tralokinumab maintained an IGA 0/1 at week 52 (results only statistically significant in ECZTRA 2).

Panelists discuss how pivotal clinical trials for atopic dermatitis biologics demonstrate both rapid and durable efficacy as monotherapy, with 3 agents—dupilumab (SOLO 1/2), lebrikizumab (ADvocate 1/2), and tralokinumab (ECZTRA 1/2)—achieving significantly higher rates of clear/almost clear skin (IGA 0/1) at week 16 vs placebo; early itch improvement by week 2; and, importantly, sustained response among initial responders at week 52, with maintenance rates varying across therapies: 50% to 70.6% for dupilumab at week 36, 74% for lebrikizumab at week 52, and 39% to 59% for tralokinumab at week 52 (statistically significant only in ECZTRA 2).

Overview of the Biologics Approved in Atopic Dermatitis

We’ll go into more detail in a bit, but can you provide a brief introduction of the biologics currently approved for atopic dermatitis, including how they differ in their mechanisms of action?

Panelists discuss how the current biologic landscape for atopic dermatitis includes 4 distinct agents with complementary mechanisms: dupilumab targeting IL-4 and IL-13 pathways to broadly inhibit type 2 inflammation, lebrikizumab and tralokinumab both selectively blocking IL-13 to potentially offer similar efficacy with refined targeting, and nemolizumab uniquely addressing the IL-31 “itch cytokine” pathway—each representing different strategic approaches to modulating the complex immunopathology of the disease with specific advantages for different patient phenotypes.

Melodie Young, MSN, A/GNP-C, FSDNP, DCNP

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