Atopic dermatitis is a chronic, inflammatory disease characterized by eczematous lesions in typical locations. It is caused by the complex interplay between genetic predisposition, environmental factors and altered skin barrier. A more precise understanding of the pathogenesis of atopic dermatitis revealed novel therapeutic options. Dupilumab, which long-term effectiveness and safety have been proven, is the first biologic available for atopic dermatitis. Other monoclonal antibodies such as nemolizumab, tralokinumab, lebrikizumab and fezakinumab demonstrated statistically significant clinical improvements in phase 2 and 3 trials. Further investigations are needed to evaluate their longterm efficacy. JAK inhibitors such as abrocitinib, baricitinib and upadacitinib showed promising effects in improvement of skin lesions and itch reduction. Beneficial immunomodulatory effect of JAK inhibitors dissipate relatively quickly with cessation of the drug, because as opposed to monoclonal antibodies, they have short half-lives. Thus, during SARS-CoV-2 infection it might be safer to use JAK inhibitors in case of necessity of a rapid immune response. There is a need to differentiate subtypes of atopic dermatitis, based on clinical symptoms and inflammatory mediators to choose an optimal therapeutic option for each patient.
Keywords: JAK inhibitors; atopic dermatitis; monoclonal antibodies.
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