@article{43d65c248a104d769f2fe6d689bc3d83,
title = "Biologic Versus Small Molecule Therapy for Treating Moderate to Severe Atopic Dermatitis: Clinical Considerations",
abstract = "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.",
keywords = "Abrocitinib, Atopic dermatitis, Baricitinib, Biologics, Cytokine signaling, Dupilumab, Eczema, Interleukin-13, Interleukin-4, Janus kinase itnhibitor, Lebrikizumab, Nemolizumab, Tralokinumab, Upadacitinib",
author = "Sneha Butala and Leslie Castelo-Soccio and Rishi Seshadri and Simpson, {Eric L.} and O'Shea, {John J.} and Thomas Bieber and Paller, {Amy S.}",
note = "Funding Information: Conflicts of interest: L. Castelo-Soccio has previously received a consultant fee in March 2021 for alopecia areata and funding in support of an autoimmune fellowship in September 2020, both from Pfizer; and serves on the medical advisory board for the National Alopecia Areata Foundation . E. L. Simpson reports grants and/or personal fees from AbbVie, Boehringer Ingelheim, Celgene, Dermavant, Dermira, Eli Lilly, Fort{\'e}Bio, Galderma, Incyte, Kyowa Kirin, LEO Pharma, MedImmune, Menlo Therapeutics, Merck, Novartis, Ortho Dermatologics, Pfizer, Pierre Fabre Dermo Cosmetique, Regeneron, Sanofi, Tioga, and Valeant. J. J. O{\textquoteright}Shea and the National Institutes of Health hold patents related to therapeutic targeting of JAKs, for which J. J. O{\textquoteright}Shea also receives royalties. T. Bieber was speaker and/or consultant and/or Investigator for AbbVie, Affibody, Almirall, AnaptysBio, Arena, Asana Biosciences, ASLAN pharma, Bayer Health, BioVerSys, B{\"o}hringer-Ingelheim, Bristol-Myers Squibb, Connect Pharma, Dermavant, DIECE Therapeutics, Domain Therapeutics, EQRx, Galderma, Glenmark, GlaxoSmithKline, Incyte, Innovaderm, IQVIA, Janssen, Kirin, Kymab, LEO, LG Chem, Lilly, {\'L}Or{\'e}al, MSD, Novartis, Numab, OM-Pharma, Pfizer, Pierre Fabre, Q32bio, RAPT, Sanofi/Regeneron, and UCB; and is founder and chairman of the board of the nonprofit biotech Davos Biosciences. A. S. Paller has been an investigator for AbbVie, Dermavant, Eli Lilly, Incyte, Janssen, Krystal, and UCB; a consultant for Aegerion Pharma, Azitra, BioCryst, Boehringer-Ingelheim, Bristol Myers Squibb, Castle Creek, Eli Lilly, Janssen, Krystal, LEO Pharma, Novartis, Regeneron, Sanofi/Genzyme, Seanergy, TWI Biotechnology, and UCB; is on the data safety monitoring board for AbbVie, Abeona, Catawba, Galderma, and InMed. The rest of the authors declare that they have no relevant conflicts of interest. Publisher Copyright: {\textcopyright} 2023 American Academy of Allergy, Asthma & Immunology",
year = "2023",
month = may,
doi = "10.1016/j.jaip.2023.03.011",
language = "English (US)",
volume = "11",
pages = "1361--1373",
journal = "Journal of Allergy and Clinical Immunology: In Practice",
issn = "2213-2198",
publisher = "Elsevier",
number = "5",
}