https://orcid.org/0000-0001-6325-7581
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ABSTRACT
Introduction
Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by erythematous lesions, pruritus, and a skin barrier defect. Long-term treatment in children is challenging, as there is only one Food and Drug Administration-approved systemic medication. Current treatments may have limited efficacy or serious side effects in children. With a deeper understanding of AD pathogenesis and the advent of target-specific medications, several biologics are undergoing clinical trials for future use in pediatric AD.
Areas covered
This article reviews the current and emerging biologic therapies for treatment of pediatric AD. It allows for comprehensive comparison of medications and their clinical trials to help providers optimize patient treatment plans while providing expert insight into upcoming advancements in the treatment of pediatric AD.
Expert opinion
Treating pediatric AD is complicated given the variety of disease severity, psychosocial impact, and relative lack of approved medications for severe disease. Given the safety data on dupilumab, newer biologics will likely be second-line. We do not yet understand the long-term impact of newer biologics on an immature immune system, nor do we fully understand their risks and toxicities. We should proceed optimistically, yet cautiously, with the study of biologics in children.
Abbreviations
| AD | = | Atopic dermatitis |
| AE | = | Adverse event |
| CCL26 | = | Chemokine (C-C motif) ligand 26 |
| EASI | = | Eczema Area and Severity Index |
| FDA | = | Food and Drug Administration |
| JAK-STAT | = | Janus kinase-signal transducer and activator of transcription |
| IGA | = | Investigator’s Global Assessment |
| IgE | = | Immunoglobulin-E |
| IL | = | Interleukin |
| IL-4Ra | = | IL-4 receptor-alpha |
| Q2w | = | Every 2 weeks |
| Q4w | = | Every 4 weeks |
| SCORAD | = | SCORing Atopic Dermatitis |
| TCS | = | Topical corticosteroid |
| Th2 | = | T helper type 2 cell |
Article highlights
AD is a common chronic skin condition with continuously increasing incidence among children.
Mild-to-moderate pediatric AD is treated with emollients and topical therapies, although chronicity and necessity for multiple treatment vehicles may add to the complexity of treatment and barriers to adherence. Moderate-to-severe disease requires phototherapy, systemic immunosuppressants, or biologics.
Current FDA-approved biologic therapies for pediatric AD include: dupilumab (anti-IL-4Rα monoclonal antibody).
Other emerging biologic therapies undergoing clinical trials include: lebrikizumab (anti-IL-13 monoclonal antibody), tralokinumab (anti-IL-13 monoclonal antibody), nemolizumab (anti-IL-31Rα monoclonal antibody), and risankizumab (anti-IL-23 monoclonal antibody).
The advent of new biologic therapies will likely allow for improved treatment of pediatric AD and attempt to address the unmet needs of AD treatment in this population.
This box summarizes key points outlined in the article.
Declaration of interest
S Feldman has received research, speaking, and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. He is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. Dr. Lindsay Strowd has received consulting fees or research funding from Galderma, Lilly, Pfizer, Sanofi, and Actelion. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.