How Emerging Therapies Are Changing the AD Treatment Landscape

Image Credit: © DermNet

In a recent interview with Dermatology Times, Emma Guttman, MD, PhD, discussed biologics for atopic dermatitis (AD), the focus of her presentation at the 2025 South Beach Symposium. As the chair of the department of dermatology at the Icahn School of Medicine at Mount Sinai in New York City, Guttman shared valuable insights on new and upcoming therapies for the condition, as well as patient best practices. Guttman and her team at Icahn see roughly two thirds of dermatology patients in the city of New York and has become 1 of the 3 largest departments in the United States.

Q&A

Dermatology Times: Are there any patient populations who are more likely to benefit from biologics over other treatment options?

Guttman: Anybody can benefit from a biologic, we always need to find the right drug for the right patient. For example, a very itchy patient. We can think about an IL-1 antagonist, the new drug. There are now multiple choices, and I think we need to find the right treatment for the right patient, and treatments are getting better and better.

DT: How do biologics impact quality of life and long-term disease control compared to conventional therapies?

Guttman: They greatly impact the quality of life. You know, patients who are itchy, uncomfortable. It's interfering with school, with work, with sleep. I’ve seen divorces, accidents, all associated with AD. Now we see that patients can be treated with a biologic and forget that they have AD. They just need to remember to inject, every 2 weeks or every 4 weeks. But it's amazing.

DT: How should clinicians counsel patients on the cost and insurance challenges of biologic treatments?

Guttman: Actually, most insurances do cover them. And of course there is a rule to pass. Patients need to fail or have tried already. What I mean by failed is they have to have tried a topical, including non steroidaltopicals, but after thatmost of the insurances will approve it. It may not be a slam dunk; physicians may need to do a prior authorization that may likely will need to do some work. So, some work is required on behalf of the physician. I think the important thing for people is that they should refer. Let's say their office is not an office that can actually do these prior authorizations.Sometimes offices are small. Just refer out. I see patients come to see me for AD from all over the United States, and they have horrible disease, and they were treated for a long time with topicals and treatments that shouldn't be given now to patients because we have other treatments. It's likely because those offices did not want to do prior authorization. That's fine, you don't have to do it. Just refer out.

DT: How do you discuss newer therapies with patients who haven’t seen a dermatology clinician in recent years?

Guttman: Many of these patients come in with very severe disease and don't even know there is something new. You need to spend some time with these patients. You need to educate them. You need to explain that if you don't treat their AD in time, they may have that systemic inflammation that is not good for you. It was associated with increased cardiovascular events and other systemic diseases. So if you have significant disease, it's good to get a systemic treatment. Otherwise, it will progress, and you will have some other diseases that you do not want to have.

DT: How do you think the world of biologics for AD will advance in the future?

Guttman: I think the future will be bi-specific. Right now, the disease is highly heterogeneous, and right now we have good treatments, but they are not covering 100% of the patient population. The majority of the patients have not achieved EASI100 yet. I think the future will have bi-specifics, tri-specifics, or disease modifying drugs. That you can stop if the disease will not come back. That's my wishful future.

[This transcript has been edited for clarity.]