Biologics for Atopic Dermatitis

You may have heard about some of the medications that are available to treat atopic dermatitis but may be wondering what makes them all different? This article will explain biologic agents, how they work, and how patients respond to them.

What are biologic drugs?

Biologic agents are medications that are targeted to treat diseases at the immune level.1 Biological agents work to block cellular pathways in your immune system that can lead to disease flares. When used for atopic dermatitis, these agents target cells in your body that cause inflammatory reactions by blocking specific proteins in your system called cytokines.1

How do biologics treat atopic dermatitis?

The currently approved biological agent for atopic dermatitis works by blocking the cytokines known as Interleukin-4 (IL-4) and Interleukin-13 (IL-13). IL-4 and IL-13 create inflammation in the body by triggering white blood cells known as eosinophils and by stimulating your immune system to make antibodies known as immunoglobulin E (IgE).2 Both eosinophils and IgE indicate to your body that you are allergic to something, even if you are not actually having an allergic reaction. Biological agents stop this inflammation process before it even starts.

How do biologics differ from other drugs?

Biological agents are different from ordinary medications. Biological agents are created using living cells, either from plants, animals, humans, or even single-celled organisms such as microbes.3 This means that each individual molecule of a biological agent is very large and complex. The process used to make these agents is very strictly controlled. Biological agents have to be made in a consistent way because even small changes in the manufacturing process can have a big impact on the way it will function in a patient’s system.3 Manufacturing of biological agents is a highly quality-controlled industry. In contrast, traditional drugs are created by adding multiple chemicals together in a specific order.3 The molecules that drugs are made of are much less complex and are much easier to manufacture. While making traditional drugs is also strictly controlled, it is easier to change the manufacturing process and alter the non-active ingredients in a drug without changing how effective the medication will be.3What is Dupixent?Currently, the only approved biological agent for atopic dermatitis is Dupixent (dupilumab), which has been approved for patients ages 6 and up. Other biological agents are being researched currently, including IL-17 and IL-22 blocking agents.2 There is also currently active research about the safety of biological agents in pediatric patients.Dupixent is an injectable medication that is given subcutaneously, or under the skin, every other week.1 The first dose, known as a loading dose, is usually higher than the subsequent doses.2 Because atopic dermatitis is a chronic disease, patients will have to remain on Dupixent indefinitely to continue to get the benefits of the agent.1How effective is Dupixent?Patients tend to respond well to biological agents. When Dupixent was given by itself, more than half of moderate to severe atopic dermatitis patients noticed a 75% reduction in their symptoms.2 When Dupiexent was combined with corticosteroids, patients saw an even greater reduction in their symptoms.2Potential side effects of DupixentSince biological agents target specific cells and how those cells interact in the body, they tend to have fewer side effects than traditional drugs. Most traditional drugs can change the chemistry of multiple systems in your body, which leads to many of the side effects that come with these medications. Common side effects of Dupixent included 1:Conjunctivitis (more commonly known as pink-eye)Injection site reactionsCold sores on the mouth and/or lipsPatients on Dupixent generally do not need laboratory monitoring while they are on treatment.2 Patients should talk with their health care team about whether starting a biological agent is the right choice for their care, especially if they are nursing, pregnant or considering getting pregnant.1

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Written by Cara King | Reviewed December 2020