Recent advances in immunomodulators for atopic dermatitis

Abstract

Purpose of review Conventional treatments of atopic dermatitis have been inadequate, especially in patients with moderate-to-severe disease. Recent findings In the past 5 years, four immunomodulators have been approved for the treatment of atopic dermatitis in children. These include dupilumab, ruxolitinib, upadacitinib, and abrocitinib. The review summarizes the pivotal phase 3 trials of these medications. Summary The newer immunomodulators have transformed the treatment of atopic dermatitis, particularly in patients with moderate-to-severe disease. Dupilumab targets IL-4 and IL-13, which are the main causes of allergic inflammation, resulting in great efficacy and few side effects. Upadacitinib and abrocitinib are alternative systemic medications for adolescents who have failed or are unable to tolerate dupilumab. Ruxolitinib cream is the latest addition to the current topical therapy. It is indicated for children 12 years and older with mild-to-moderate atopic dermatitis. Further studies are needed to confirm its safety and efficacy for younger children and for patients with more severe disease.

From neglect to spotlight: the underappreciated role of B cells in cutaneous inflammatory diseases

“…While a 16 to 52-week phase 3 clinical trial of dupilumab did not indicate elevated infectious disease occurrence ( 159 – 161 ), the potential prolonged suppressive influence of IL-4R on maintaining naive B cell homeostasis and proper vaccination response remains uncertain. Indeed, the most common adverse effects of dupilumab, as reported by the U.S. FDA and other institutions, encompass conjunctivitis, upper respiratory tract infections, and skin infections ( 162 ). This underscores the potential susceptibility and complications resulting from disruptions in humoral immunity due to impaired IL-4 signaling, eventually making individuals more susceptible to various external threats.…”