Biologicals for pediatric patients with atopic dermatitis: practical challenges and knowledge gaps

Abstract

Biologicals are becoming increasingly important in the therapeutic landscape of pediatric patients with moderate-to-severe atopic dermatitis (AD). Currently, dupilumab and tralokinumab are registered for the treatment of moderate-to-severe AD, and novel biologicals are expected to follow. Dupilumab was the first biological registered for AD in pediatric patients and was recently approved for patients aged six months to five years. Current and emerging biologicals may address the unmet need for effective and safe treatment options for pediatric AD patients, however, little is known about the practical implementation of biologicals in infants and preschoolers (aged <6 years), including the timing of treatment initiation, discontinuation, and long-term administration of the subcutaneous injections. Currently, only a small number of biologicals are approved for the treatment of infants and preschoolers for other inflammatory diseases. Consequently, data on the practical implementation of biological treatment remain scarce. In addition, long-term effects, impact on co-morbidities, and impact on live-accentuated vaccination are still unknown. With the introduction of biologicals for AD from the age of six months, potential challenges within the implementation of biologicals may arise. Therefore, we aim to discuss current practical challenges and knowledge gaps of the treatment with biologicals in infants and preschoolers with AD.

Keywords:

• Atopic dermatitis
• biological therapy
• pediatric dermatology
• immunomodulating therapy
• children

Disclosure statement

• Lisa P. van der Rijst is a speaker for AbbVie.

• Suzanne G.M.A. Pasmans has been a consultant, advisory board member, and/or speaker for Leo Pharma, Pfizer, Regeneron, and Sanofi-Genzyme.

• Renske Schappin has no conflicts of interest.

• Annet van Royen-Kerkhof has received travel grants, speaking fees (less than €1000,-) for Novartis, Roche, Shire, AbbVie, SOBI, and Baxalta.

• Marjolein S. de Bruin-Weller has been a consultant, advisory board member, and/or speaker for AbbVie, Almirall, Amgen, Aslan, Eli Lilly, Galderma, Janssen, Leo Pharma, Pfizer, Regeneron, and Sanofi-Genzyme

• Marlies de Graaf is a consultant, advisor and/or speaker for AbbVie, Eli Lilly, Janssen, LEO Pharma, Novartis, Pfizer, Regeneron Pharmaceuticals and Sanofi.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.

Additional information

Funding

This work was not supported by funding.