Biologic Versus Small Molecule Therapy for Treating Moderate to Severe Atopic Dermatitis: Clinical Considerations

Sneha Butala, Leslie Castelo-Soccio, Rishi Seshadri, Eric L. Simpson, John J. O'Shea, Thomas Bieber, Amy S. Paller*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The U.S. Food and Drug Administration approval of dupilumab for moderate-to-severe atopic dermatitis shifted the paradigm from use of broad, systemic immunosuppressants to a safer, targeted treatment and led to the emergence of newer interleukin (IL)-4/IL-13 directed biologics and small molecule therapies, namely Janus kinase (JAK) inhibitors (JAKi). Tralokinumab and emerging (not yet approved) lebrikizumab, which both target IL-13, are alternative biologics to dupilumab. The emerging anti–IL-31 receptor nemolizumab is likely to be used second-line to other biologics, primarily for pruritus. Three JAKi are currently in use for treating atopic dermatitis, 2 of which, abrocitinib and upadacitinib, are U.S. Food and Drug Administration–approved. This review provides an in-depth, practical discussion on use of these biologics and JAKi that are approved or have completed phase 3 clinical trials in pediatric patients and adults, comparing the groups of medications based on available efficacy and safety data.

Original languageEnglish (US)
Pages (from-to)1361-1373
Number of pages13
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number5
StatePublished - May 2023


  • Abrocitinib
  • Atopic dermatitis
  • Baricitinib
  • Biologics
  • Cytokine signaling
  • Dupilumab
  • Eczema
  • Interleukin-13
  • Interleukin-4
  • Janus kinase itnhibitor
  • Lebrikizumab
  • Nemolizumab
  • Tralokinumab
  • Upadacitinib

ASJC Scopus subject areas

  • Immunology and Allergy


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