Biologics in the treatment of atopic dermatitis: approved active substances and monoclonal antibodies in advanced clinical trials

Abstract Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in industrialized countries and is characterized by heterogeneous (endo)phenotypes and a high disease burden. In Europe, four biologics and three oral Janus kinase (JAK) inhibitors are currently approved by the European Medicines Agency (EMA) for the treatment of moderate to severe AD in adolescents (≥ 12 years) and adults: dupilumab (anti-interleukin [IL]-4Rα; 2017), tralokinumab (anti-IL-13; 2021), lebrikizumab (anti-IL-13; 2023) and nemolizumab (anti-IL-31Rα; 2024) as well as the JAK inhibitors baricitinib (JAK 1/2; 2020), upadacitinib (JAK 1; 2021) and abrocitinib (JAK 1; 2022). Among the abovementioned therapies, baricitinib for moderate and severe AD from the second year of life and dupilumab for severe AD from the sixth month of life are already two approved systemic therapies for early childhood. This narrative review provides an update on the biologics currently approved for treatment of moderate and severe AD. It also provides a brief overview of monoclonal antibodies currently in phase III clinical trials and future issues and opportunities for immunomodulatory systemic therapies for AD.