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Papers of the Week

Papers: 18 Mar 2023 - 24 Mar 2023


Pharmacology/Drug Development


2023 Mar 20

J Allergy Clin Immunol Pract


Biologic versus small molecule therapy for treating moderate to severe atopic dermatitis: clinical considerations.


Butala S, Castelo-Soccio L, Seshadri R, Simpson EL, O'Shea JJ, Bieber T, Paller AS


FDA approval of dupilumab for moderate-to-severe AD 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. Tralokinumab and emerging (not yet approved) lebrikizumab, which both target IL-13, are alternative biologics to dupilumab. Emerging anti-IL-31 receptor nemolizumab is likely to be used second-line to other biologics, primarily for pruritus. Three JAK inhibitors are currently in use for treating AD, two of which, abrocitinib and upadacitinib, are FDA-approved. This review provides an in-depth, practical discussion on use of these biologics and JAK inhibitors 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.