Abstract
The era of biologics for the treatment of moderate-to-severe atopic dermatitis (AD) began in 2017 with the approval of dupilumab, a monoclonal antibody that binds to the α-subunit of the interleukin IL-4 receptor. Until then, only conventional immunosuppressants were available for systemic treatment, of which only cyclosporine is approved for the treatment of severe AD. In the meantime, the therapeutic landscape of AD has been changing rapidly, and additional biologics have been developed which target IL-13, the IL-31 receptor, OX40, and OX40L, among others. Many of these substances have already shown promising results in phase 1, 2, and in some cases also phase 3 trials. In June 2021, tralokinumab, an IL-13 antibody, has been approved in Europe for the treatment of moderate-to-severe AD in adults. In addition to antibody-based therapies, “small molecules” that, e.g., inhibit Janus kinases enrich the armamentarium of systemic AD therapies. With all these agents, not only will many more targeted therapies become available, but also will the complex and heterogeneous pathophysiological processes of this disease be better understood.
Highlights
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases
The era of biologics for the treatment of moderate-to-severe atopic dermatitis (AD) began in 2017 with the approval of dupilumab, a monoclonal antibody that binds to the α-subunit of the interleukin IL-4 receptor
Only conventional immunosuppressants were available for systemic treatment, of which only cyclosporine is approved for the treatment of severe AD
Summary
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. For a long time, only conventional immunosuppressants were available to treat severe forms of AD that could not be adequately controlled with topical treatment alone [1]. After 16 weeks, 37% of patients treated with dupilumab had achieved complete or almost complete symptom clearance compared to 9% in the placebo group. In the LIBERTY AD CHRONOS phase 3 study, in Stölzl, Weidinger, and Drerup which all patients were allowed to use topical glucocorticosteroids (TCS) and/or topical calcineurin inhibitors (TCI), 39% of the dupilumab patients achieved complete or almost complete clearance of the skin after 16 weeks vs 12% in the placebo group.
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