From the Guidelines
Targeted therapy for atopic dermatitis includes dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib as the most effective options, with dupilumab being the first-line biologic treatment. These medications have been shown to be effective in managing atopic dermatitis in adults, with strong recommendations for their use in the latest guidelines 1. The guidelines highlight the importance of shared decision-making between patients and clinicians when initiating these advanced therapies, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions.
Some key points to consider when selecting a targeted therapy for atopic dermatitis include:
- Disease severity: Patients with moderate-to-severe disease may benefit from biologic treatments like dupilumab or tralokinumab.
- Affected areas: Topical treatments like calcineurin inhibitors may be effective for milder cases or localized disease.
- Patient age and comorbidities: Certain medications may be more suitable for specific patient populations, such as JAK inhibitors for adults with moderate-to-severe disease.
- Potential side effects: Regular monitoring is necessary to minimize the risk of adverse events, such as injection site reactions with dupilumab or infection risk with JAK inhibitors.
The latest guidelines also emphasize the need for long-term maintenance therapy and regular monitoring for potential side effects 1. By considering these factors and selecting the most appropriate targeted therapy, clinicians can help improve disease control and quality of life for patients with atopic dermatitis.
From the FDA Drug Label
DUPIXENT is an interleukin-4 receptor alpha antagonist indicated: Atopic Dermatitis for the treatment of adult and pediatric patients aged 6 months and older with moderate-to-severe AD whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable.
The target therapy for atopic dermatitis patients is dupilumab, an interleukin-4 receptor alpha antagonist. It is indicated for the treatment of adult and pediatric patients aged 6 months and older with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable 2.
- Key points:
- Indication: Moderate-to-severe atopic dermatitis
- Patient population: Adult and pediatric patients aged 6 months and older
- Mechanism of action: Interleukin-4 receptor alpha antagonist
- Administration: Subcutaneous injection
- Dosage: Initial dose of 600 mg, followed by 300 mg every other week (Q2W) for adults, with varying dosages for pediatric patients based on weight and age.
From the Research
Target Therapy for Atopic Dermatitis
- Target therapy for atopic dermatitis patients involves the use of biologic agents that target specific components and regulators of the inflammatory pathways in allergic and inflammatory conditions 3.
- Dupilumab, a fully human monoclonal antibody targeting the interleukin (IL)-4 receptor α, is one of the first biologics that has been developed for atopic dermatitis and has shown promising results in phase III trials 4, 5.
- Dupilumab works by blocking the IL-4 and IL-13 pathway, which is involved in the pathogenesis of atopic dermatitis 4, 5.
- Other monoclonal antibodies targeting IL-5, IL-13, IL-17, IL-22, IL-23, IL-31, and TSLP are currently under investigation for the treatment of moderate to severe atopic dermatitis 6.
- Small molecules like anti-PDE4 and JAK inhibitors may also represent other treatment possibilities for atopic dermatitis 6.
Mechanism of Action
- Dupilumab binds to the shared chain of the interleukin-4 and interleukin-13 receptor, blocking the downstream signaling of these cytokines 5.
- The clinical improvements induced by dupilumab are associated with remission of the dysregulated immune mechanisms linked with atopic dermatitis 5.
- Dupilumab reverses the epidermal barrier defects and improves the global molecular signature of atopic dermatitis 5.
Current Status
- Dupilumab has been approved by the US Food and Drug Administration and the European Commission for the treatment of moderate to severe atopic dermatitis 4.
- The availability of specific drugs for atopic dermatitis, such as dupilumab, will open up a new era in dermatological therapy 7.
- There is an urgent need for new therapeutic options for atopic dermatitis, and research has made enormous progress in understanding the mechanisms involved in its pathogenesis 7.