Biologics to Treat Eczema

Atopic dermatitis, or eczema, is a complex disease. It is caused by factors both outside and inside the body. Problems with the skin barrier play a role. But beneath the skin, an problems with the immune system also contribute to eczema symptoms.¹

Topical treatments can reduce the redness, itching, and inflammation at the surface of the skin. But in some cases, therapies that target the immune system are also needed. These are called systemic therapies.¹

Biologics are a type of systemic therapy for eczema. They are drugs that can calm the immune system throughout the body. Biologics reduce the inflammatory response that drives eczema beneath the skin.¹

When are biologics recommended?

Whether someone uses biologics to treat their eczema depends upon many factors. This is a decision to be made between you and your doctor. Your doctor may recommend biologics if:²

• Topical treatments do not work for you.
• You cannot or do not want to use steroids.
• You have tried an immunosuppressant or you cannot take one.
• Your eczema is moderate to severe.
• Your eczema is affecting your mental or social health.

How do biologics work?

Biologics are drugs made from living cells. These cells can come from parts of the blood, proteins, viruses, or tissue. In this way, biologics are different from most traditional drugs. Traditional drugs are made from chemicals in a lab rather than from living cells.³

Biologics for eczema fight inflammation from inside the body. They target certain immune proteins called interleukins (ILs). People with eczema have higher than normal levels of 2 kinds of ILs: IL-4 and IL-13. These 2 ILs drive a series of reactions that cause inflammation, changes in the skin barrier, and changes to fat levels in the skin.^4-6

Biologics that target IL-4 and IL-13 can lessen or block the effects of these proteins. Biologics may slow or stop the immune system’s inflammatory response. In turn, they reduce the symptoms of eczema.^1,4

Examples

As of late 2022, 2 biologics have been approved by the US Food and Drug Administration (FDA) to treat eczema:^4,7-10

• Dupixent® (dupilumab) – Approved for adults and children ages 6 months and older with moderate to severe atopic dermatitis
• Adbry® (tralokinumab) – Approved for adults with moderate to severe atopic dermatitis

Both Dupixent and Adbry are given by an injection beneath the skin.^4,7-10

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking.

The most common side effects of Dupixent include:^7,9

• Injection site reactions
• Upper respiratory tract infections
• Pink eye (conjunctivitis)
• Throat pain
• Cold sores in the mouth or on the lips
• High levels of white blood cells called eosinophils (eosinophilia)
• Trouble sleeping (insomnia)
• Toothache
• Redness and swelling of the stomach lining (gastritis)
• Joint pain
• Parasitic infections

The most common side effects of Adbry include:^8,10

• Pink eye
• Injection site reactions
• High levels of white blood cells called eosinophils (eosinophilia)

These are not all the possible side effects of biologics. Talk to your doctor about what to expect when taking a biologic drug. You also should call your doctor if you have any changes that concern you when taking biologics.

Other things to know

There have not yet been any clinical trials to compare Dupixent and Adbry directly. But researchers are studying new biologics to treat eczema.^7,8

Over time, biologics can lose their effectiveness. This is because the body may build up a tolerance for them called immunogenicity.^7,8

Before taking a biologic, tell your doctor if you:^7,8

• Have eye problems
• Have a parasitic infection
• Are scheduled to receive any vaccines. You should not receive certain vaccines before and during treatment with a biologic.
• Are pregnant, plan to become pregnant, or are breastfeeding. Doctors do not yet know how these drugs affect pregnancy or breast milk.

Before beginning treatment for eczema, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.