BIOLOGIC AND TARGETED THERAPIES IN ATOPIC DERMATITIS: A BIOMARKER-INFORMED FRAMEWORK FOR PERSONALIZED TREATMENT SELECTION
Abstract
Background: Atopic dermatitis is a chronic inflammatory skin disease characterized by pruritus, eczematous lesions, and impaired quality of life. Advances in understanding type 2 immune dysregulation have led to the development of biologic and targeted systemic therapies; however, treatment response remains heterogeneous, highlighting the need for personalized therapeutic strategies.
Objective: To review current biologic and targeted systemic therapies for moderate-to-severe atopic dermatitis, examine the role of clinical and molecular biomarkers in predicting treatment response, and propose a biomarker-informed framework for personalized treatment selection.
Methods: A narrative review was conducted of literature published between January 2020 and July 2024 using major scientific databases. Included publications comprised randomized controlled trials, cohort studies, systematic reviews, and expert consensus documents addressing systemic therapies, biomarker associations, and stratified treatment approaches in atopic dermatitis.
Results: Biologic agents, including dupilumab, tralokinumab, lebrikizumab, and nemolizumab, are associated with substantial improvements in skin inflammation and pruritus and demonstrate favorable safety profiles across diverse patient populations. Janus kinase inhibitors provide rapid symptom control but require careful patient selection due to safety considerations. Biomarkers such as thymus and activation-regulated chemokine, eotaxin-3, periostin, eosinophil count, and interleukin-13 gene expression contribute to the characterization of disease endotypes and may support biologically informed treatment decisions.
Conclusions: Biologic and targeted systemic therapies have transformed the management of atopic dermatitis; however, optimal outcomes depend on individualized treatment selection. Biomarker-informed approaches offer a rational framework to reduce empirical treatment cycling and advance precision medicine in atopic dermatitis, although further validation in real-world clinical settings is required.
References
Bakker, D., De Bruin-Weller, M., Drylewicz, J., Van Wijk, F., & Thijs, J. (2023). Biomarkers in atopic dermatitis. Journal of Allergy and Clinical Immunology, 151(5), 1163–1168. https://doi.org/10.1016/j.jaci.2023.01.019
Blauvelt, A., Teixeira, H. D., Simpson, E. L., Costanzo, A., De Bruin-Weller, M., Barbarot, S., Prajapati, V. H., Lio, P., Hu, X., Wu, T., Liu, J., Ladizinski, B., Chu, A. D., & Eyerich, K. (2021). Efficacy and safety of upadacitinib vs dupilumab in adults with moderate-to-severe atopic dermatitis: A randomized clinical trial. JAMA Dermatology, 157(9), 1047–1055. https://doi.org/10.1001/jamadermatol.2021.3023
Davis, D. M. R., Drucker, A. M., Alikhan, A., Bercovitch, L., Cohen, D. E., Darr, J. M., Eichenfield, L. F., Frazer-Green, L., Paller, A. S., Schwarzenberger, K., Silverberg, J. I., Singh, A. M., Wu, P. A., & Sidbury, R. (2024). Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. Journal of the American Academy of Dermatology, 90(2), e43–e56. https://doi.org/10.1016/j.jaad.2023.08.102
Deleuran, M., Dézfoulian, B., Elberling, J., Knutar, I., Lapeere, H., Lossius, A. H., Schuttelaar, M. L. A., Stockman, A., Wikström, E., Bradley, M., De Bruin‐Weller, M., Gutermuth, J., Mandelin, J. M., Schmidt, M. C., Thyssen, J. P., & Vestergaard, C. (2024). Systemic anti‐inflammatory treatment of atopic dermatitis during conception, pregnancy and breastfeeding: Interdisciplinary expert consensus in Northern Europe. Journal of the European Academy of Dermatology and Venereology, 38(1), 31–41. https://doi.org/10.1111/jdv.19512
Drucker, A. M., Ellis, A. G., Bohdanowicz, M., Mashayekhi, S., Yiu, Z. Z. N., Rochwerg, B., Di Giorgio, S., Arents, B. W. M., Burton, T., Spuls, P. I., Küster, D., Siegels, D., Schmitt, J., & Flohr, C. (2020). Systemic Immunomodulatory Treatments for Patients With Atopic Dermatitis: A Systematic Review and Network Meta-analysis. JAMA Dermatology, 156(6), 659–667. https://doi.org/10.1001/jamadermatol.2020.0796
Kabashima, K., Matsumura, T., Komazaki, H., & Kawashima, M. (2020). Trial of Nemolizumab and Topical Agents for Atopic Dermatitis with Pruritus. New England Journal of Medicine, 383(2), 141–150. https://doi.org/10.1056/NEJMoa1917006
Libon, F., Caron, J., & Nikkels, A. F. (2024). Biomarkers in Atopic Dermatitis. Dermatology and Therapy, 14(7), 1729–1738. https://doi.org/10.1007/s13555-024-01193-1
Renert-Yuval, Y., Thyssen, J. P., Bissonnette, R., Bieber, T., Kabashima, K., Hijnen, D., & Guttman-Yassky, E. (2021). Biomarkers in atopic dermatitis—A review on behalf of the International Eczema Council. Journal of Allergy and Clinical Immunology, 147(4), 1174-1190.e1. https://doi.org/10.1016/j.jaci.2021.01.013
Silverberg, J. I., Pinter, A., Pulka, G., Poulin, Y., Bouaziz, J.-D., Wollenberg, A., Murrell, D. F., Alexis, A., Lindsey, L., Ahmad, F., Piketty, C., & Clucas, A. (2020). Phase 2B randomized study of nemolizumab in adults with moderate-to-severe atopic dermatitis and severe pruritus. Journal of Allergy and Clinical Immunology, 145(1), 173–182. https://doi.org/10.1016/j.jaci.2019.08.013
Simpson, E. L., Sinclair, R., Forman, S., Wollenberg, A., Aschoff, R., Cork, M., Bieber, T., Thyssen, J. P., Yosipovitch, G., Flohr, C., Magnolo, N., Maari, C., Feeney, C., Biswas, P., Tatulych, S., Valdez, H., & Rojo, R. (2020). Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): A multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. The Lancet, 396(10246), 255–266. https://doi.org/10.1016/S0140-6736(20)30732-7
Views:
37
Downloads:
0
Copyright (c) 2026 Zuzanna Karolina Jędrzejczak, Paweł Jan Babiński, Magdalena Wiśniewska, Andrzej Józef Horabik, Małgorzata Dmochowska, Julia Hertmanowska, Marta Piotrowska, Krzysztof Chmura, Adrianna Alicja Piekarska, Gabriela Kryger
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
