Biologics are some of the newest treatment options for atopic dermatitis. Biologics have been around for years as treatment options for many conditions that affect the immune system, but the FDA didn’t approve them for treating atopic dermatitis until 2017.
Biologics work differently than other atopic dermatitis treatments. Instead of treating general inflammation all over your body, they target specific molecules. Scientists modify the genes of bacteria and cells in a lab and use those living organisms to make biologic drugs.
The FDA has approved only two biologics to treat atopic dermatitis: dupilumab and tralokinumab. Both are a type of biologic called a monoclonal antibody. Biologics that are monoclonal antibodies have a name that ends with -mab. Several other monoclonal antibodies are being studied and may get FDA approval soon.
How Biologics Work
Monoclonal antibodies are a type of protein researchers make in a lab to mimic your body’s natural antibodies. Antibodies are part of your immune system. They help identify substances that shouldn’t be in your body and force other parts of your immune system to destroy them or block them from getting certain signals.
The way antibodies find these foreign substances is by seeking out certain proteins on the surface of the substance.
Once researchers figure out a specific antigen to target – such as one involved in atopic dermatitis symptoms – they can create monoclonal antibodies that fit these antigens and help treat the symptoms.
Dupilumab and tralokinumab both treat atopic dermatitis by targeting chemical messengers called interleukins (ILs). ILs help turn on the inflammation process in your body. Both drugs block receptors on your cells so that certain ILs can’t attach to them.
It’s as if these biologics cover up a keyhole (the cell receptor) so a key (the IL) can’t go in and start the ignition that would turn on the car (inflammation).
This biologic is approved for people ages 6 and older. You have to have a prescription to get it. You give it to yourself as an injection under the skin every other week or once a month. Your doctor will prescribe either a pre-filled syringe or a pen with the correct dose in it.
You can’t take it in pill form because your digestive system would break it down and it wouldn’t work.
Dupilumab keeps your immune system from overreacting by targeting IL-4 and IL-13. These ILs also play a part in how well your skin works as a barrier. By blocking them, dupilumab helps strengthen your skin’s ability to protect you from germs and irritants.
The most common side effects include:
- Pinkeye (conjunctivitis)
- Infection at your injection site
- Cold sores on your lips and in your mouth
Tralokinumab is the newest biologic option for treating atopic dermatitis. The FDA approved it in December 2021. This biologic targets IL-13 only. It works similarly to dupilumab, blocking IL-13 so it doesn’t turn on the inflammation process.
You inject it under your skin every other week. Only people 18 years old and above can take it.
Side effects include:
- Upper respiratory tract infections
- Infection at your injection site
Because biologics are targeted therapies and don’t go through your whole system, they tend to cause fewer side effects than other treatments. You can use topical treatments in combination with both tralokinumab and dupilumab.
Who Should Take Biologics for Atopic Dermatitis?
Most people can treat their AD with prevention, topical treatments, UV therapy, and by maintaining skin care. Doctors typically wait to prescribe biologics until after you’ve tried other treatment options for AD or have severe AD.
Often they’ll want you to have tried at least one immunosuppressive drug first. If that treatment doesn’t work, biologics may be the best treatment for you. Some people can’t take immunosuppressive drugs because of the side effects, so biologics make more sense as a treatment.
Although dupilumab is OK for kids as young as 6, doctors may only go that route if the child’s AD is severe. After 12 years, doctors will consider it for moderate cases.
Doctors usually look at how much of your skin is affected and how intense your symptoms are to figure out whether you have a mild, moderate, or severe AD. Along with skin symptoms, they’ll need to know how your AD impacts your life. If it’s getting in the way of your daily activities, even if it doesn’t affect a lot of your skin area, you may need a biologic to help keep it under control.
Who Shouldn’t Take Biologics for Atopic Dermatitis?
There are a few reasons your doctor might not recommend a biologic for your AD treatment or suggest you wait to try it at another time. These include:
- You’re scheduled for a live vaccine. Because biologics have an impact on your immune system, you shouldn’t get any live vaccines while taking them.
- You’re pregnant or breastfeeding. There’s not much information yet about how biologics might affect breast milk or unborn babies.
- You have an allergic reaction to them. If you get a rash, have trouble breathing, or other symptoms of an allergic reaction, tell your doctor.