Initiating Biologics in Atopic Dermatitis: Global Practices and Recommendations from the AMAZE Project

Biologics have expanded treatment options for moderate-to-severe atopic dermatitis (AD), but practical guidance on how to initiate and manage these therapies in routine care remains limited. The advancing management of atopic dermatitis and eczema (AMAZE ) project examined global clinical practices and developed expert-informed recommendations to support biologic initiation and long-term management. An online survey of 150 dermatologists from North America, Europe, and Japan assessed real-world approaches to biologic management. Findings were interpreted by an international global steering committee and further refined through expert discussion meetings. Best practice recommendations were developed on the basis of survey findings, expert consensus, and a narrative literature review. Respondents reported considerable variability in biologic initiation practices. Overall, 47% of dermatologists intended biologic therapy for long-term use, while Japanese clinicians more frequently anticipated shorter treatment durations (4–12 months), reflecting national guideline recommendations. Transition practices from conventional systemic therapies varied substantially between dermatologists: 49% reported overlapping, 33% transitioned directly without overlap, and 18% used a washout period. European clinicians were more likely to discontinue conventional systemic therapies prior to biologic initiation, whereas overlapping strategies were more common in North America and Japan. Early follow-up within 4 weeks was reported by 36% of dermatologists and was most common in Japan, largely owing to healthcare system requirements. Expert-informed recommendations emphasized: establishing patient-centered treatment goals focused on long-term disease control; individualized transition strategies when switching from conventional systemic therapies; structured follow-up with formal assessment of treatment response around 12–16 weeks after treatment initiation; and proactive management of flares through continued use of emollients and topical anti-inflammatory therapies. The AMAZE project highlights substantial regional variation in biologic initiation practices for AD. These expert-informed recommendations provide practical guidance to support individualized, patient-centered approaches to initiating and managing biologic therapy in routine clinical practice. Graphical plain language summary available for this article at https://doi.org/10.6084/m9.figshare.32991755 . Biologics can improve signs and symptoms in people with moderate-to-severe atopic dermatitis. However, because these treatments are still fairly new, there is uncertainty about the best way to use them in everyday care. In this project, we looked at how biologics are currently used and how this could be improved. We focused on four main areas: what patients may expect from a biologic, how to switch from an existing treatment to a biologic, when to schedule follow-up after starting a biologic, and how to manage flare-ups when on a biologic. We conducted a survey of dermatologists from North America, Europe, and Japan. The results showed that there is a lot of variation between countries in how patients are started and followed on a biologic. For example, some doctors prefer to stop the current treatment before starting a biologic, while others will initially combine the two treatments. Also, some doctors review their patients within the first month of treatment, while others wait a few months to see how well the treatment is working. We also brought together a group of doctors and a nurse practitioner who are experts in using biologics for eczema. They reviewed the survey results and medical guidelines. During several meetings, they agreed on practical ways to improve everyday care. Their advice focused on the importance of doctors and patients making decisions together and the need to clearly explain what treatments can realistically do. They also recommended that treatment changes and follow-up should fit each person’s individual needs.