Choosing Biologics for AD: Update Presented at ACAAI

What factors can help you choose the most appropriate treatment option for patients with atopic dermatitis (AD)? In her talk at the American College of Allergy, Asthma and Immunology (ACAAI) 2023 Annual Scientific Meeting, Karen S. Hsu Blatman, MD, shared the latest updates and factors to consider when choosing a biologic for patients with AD.

Blatman, section chief of allergy and clinical immunology and assistant professor of medicine at Geisel School of Medicine, Dartmouth, began her talk by discussing dupilumab, an interleukin (IL)-4 and IL-13 inhibitor that was the first approved biologic by the US Food and Drug Administration for AD. She reminded attendees the fully human IL-4Rα monoclonal antibody was originally approved in 2017 for adults, but is now approved for patients 6 months old and older. Dosing for dupilumab for AD in children is 200 mg every 4 weeks for patients 11-32 lbs and 300 mg every 4 weeks for those who are 33-65 lbs.

Blatman also discussed tralokinumab, which targets IL-13 and was approved in 2021 for adults 18 years and older with AD. Interestingly, it is approved for children aged 12 years and older in Europe and Canada. She explained it is anti-IL 13 monoclonal antibody that prevents IL-13 from binding to both IL-13Rα1 and IL-13Rα2. Dosing is 600 mg SQ divided 4 sites then 300 mg SQ every 14 days.

Looking forward, there are some agents of interest, Blatman told attendees. Nemolizumab received FDA breakthrough designation for treating pruritus in 2019, and was approve in 2022 in Japan for patients 13 years and older with severe atopic dermatitis. It inhibits activation of the IL-31 receptor, she explained, which is the protein implicated in chronic pruritus.¹

She also discussed lebrikizumab, another anti-IL-13 player. Research indicated that lebrikizumab resulted in improved skin clearance in adults and adolescents with moderate to severe AD in comparison with placebo, Blatman noted.²

With the new ACAAI guidelines on AD, clinicians will have further support in considering treatments, Blatman said. She reminded attendees that dosing biologics will be dependent on age and weight, and that topical therapies will likely be needed in addition to biologics to achieve optimal outcomes for patients.

”I certainly love working with my dermatology colleagues,” Blatman shared with Dermatology Times. “For those who usually think that you are referring over to allergy to help see if there's any sort of component of allergy to the atopic dermatitis, I would like to continue to partner with you on that. For patients that we are referring over, I think a lot of it is that our differential may include more our concern that it may be more than just a contact dermatitis. I hope that allergy and dermatology continue to collaborate a lot on these cases.”

References

1. Kabashima K, Matsumura T, Komazaki H, Kawashima M; Nemolizumab-JP01 Study Group. Trial of Nemolizumab and Topical Agents for Atopic Dermatitis with Pruritus. N Engl J Med. 2020;383(2):141-150. doi:10.1056/NEJMoa1917006

2. Silverberg JI, Guttman-Yassky E, Thaçi D, et al. Two Phase 3 Trials of Lebrikizumab for Moderate-to-Severe Atopic Dermatitis. N Engl J Med. 2023;388(12):1080-1091. doi:10.1056/NEJMoa2206714