Dr. Ahmed Eczema is a skin condition that presents with a dry flaky skin caused by internal inflammation. There are symptoms like itching, redness, and skin thickening.
Traditional treatments include topical corticosteroids, moisturizers, and lifestyle changes, but these may not be effective for everyone, especially those with moderate to severe forms of the disease.
In recent years, biologic treatments have emerged as a promising option for managing atopic dermatitis.
This article will focus on comparing Dupixent (dupilumab), one of the most widely used biologics for atopic dermatitis, with other biologic treatments.
Biologics for Atopic Dermatitis
Biologics are a class of drugs targeting specific components of the immune system engaged in the disease process.
For atopic dermatitis, biologics aim to reduce inflammation and prevent flare-ups by blocking key cytokines or receptors involved in the immune response.
These targeted therapies offer a new approach for patients who have not responded well to conventional treatments.
Dupixent (Dupilumab)
Dupilumab is a type of monoclonal antibody under the brand name Dupixent, which interferes with the interleukin-4 receptor alpha subunit in such a manner that it results in the interference of IL-4 and IL-13 signals.
These two interleukins have been pivotal in the course of atopic dermatitis and trigger inflammation.
Additionally, this affects the protective mechanism of the skin. For atopic dermatitis, moderate to severe symptoms are treated using Dupilumab in patients six months or older.
Other Biologic Treatments
Here are some of the other biologic drugs that are used for the treatment of eczema.
Tralokinumab
Another monoclonal antibody approved for atopic dermatitis, tralokinumab specifically targets IL-13, a key cytokine involved in the disease.
It is used for adults with moderate to severe atopic dermatitis. By focusing on IL-13, tralokinumab offers an alternative for patients who may not respond to the broader IL-4/IL-13 inhibition provided by dupilumab.
Upadacitinib:
Although not a monoclonal antibody, Upadacitinib is a Janus kinase (JAK) inhibitor that has been effective in treating atopic dermatitis by decreasing inflammation.
Although it is not a biologic, it is often mentioned in biologics because of its targeted mechanism of action. An oral treatment may be more acceptable to some patients than injectable biologics.
Comparison of Biologic Treatments
The following table compares Dupixent with other biologic treatments for atopic dermatitis:
| Treatment | Target | Indication | Administration | Common Side Effects |
| Dupilumab (Dupixent) | IL-4/IL-13 signaling | Moderate to severe AD in adults and children ≥6 months | Subcutaneous injection every 2 weeks (after initial doses) | Conjunctivitis, injection site reactions, nasopharyngitis |
| Tralokinumab | IL-13 | Moderate to severe AD in adults | Subcutaneous injection every 2 weeks | Injection site reactions, upper respiratory tract infections |
| Adbry (Tralokinumab-ldrm) | IL-13 | Moderate to severe AD in adults | Subcutaneous injection every 2 weeks | Similar to tralokinumab, with injection site reactions common |
| Upadacitinib | JAK1/JAK3 inhibition | Moderate to severe AD in adults | Oral tablets once daily | Nausea, headache, increased risk of infections |
Dupixent vs Other Biologics – Mechanism of Action
| Dupilumab: | Tralokinumab: | Upadacitinib: |
| Through inhibition of IL-4 and IL-13, dupilumab reduces inflammation and improves skin barrier function. This leads to reduced itching and skin lesions in patients. | It specifically targets IL-13, which is involved in the TH2 immune response, thereby reducing inflammation and improving symptoms of atopic dermatitis. Its targeted approach may be advantageous for patients with a strong IL-13 component in their disease. | It works by inhibiting Janus kinases (JAKs), which are enzymes involved in the signaling of multiple cytokines. This broad inhibition can reduce inflammation but may also increase the risk of infections due to its impact on the immune system. |
Dupixent vs Other Biologics – Efficacy
Clinical trials have shown significant improvements in atopic dermatitis severity scores (EASI, SCORAD) and quality of life measures (DLQI) with dupilumab treatment. It has been effective in reducing symptoms and improving skin clearance.[Ref]
Although there are no head-to-head comparisons, one real-world analysis demonstrated that some patients might find dupilumab treatment ineffective.
Although dupilumab is the first choice treatment in moderate to severe cases of atopic dermatitis, 3 to 5% patients discontinue the treatment due to inefficacy.
The study concluded that 59 % of patients who switched from dupilumab to tralokinumab achieved complete to partial symptom resolution. [Ref]
However, some studies suggest that using dual inhibition of IL-4 and IL-13 is a better treatment approach than targeting IL-13 alone. That is why, some patients with tralokinumab failure also switch to dupilumab. [Ref]
In another study, 75% reduction in Eczema Area and Severity Index (EASI) was seen with a high dose of Upadacitinib (30mg) and abrocitinib. Both these drugs outperformed dupilumab. [Ref]
Another 32-week study concluded that in combination with topical steroids, both tralokinumab and dupilumab showed similar efficacy. [Ref]
Cost and Accessibility
The cost of dupilumab and tralokinumab is usually much higher than the conventional topical treatment. However, for those who are not responsive to traditional therapies, they do have some advantages.
The coverage from insurance and patient assistance programs also makes it easier for them to afford the treatments.
Further studies are already underway to evaluate the cost-effectiveness of these biologics so that the long-term value of the treatment can be established.
Patient Selection
There are various requirements to choose the correct biologic therapy for atopic dermatitis, including matched individualized cytokine profiles, past responses, and choice based on personal preference in terms of the drug’s modality.
Upadacitinib would become more beneficial for those who prefer oral modalities, while others who may not have responded well to the monotherapy with the inhibition of IL-13 may do better with dupilumab.
Conclusion
Dupixent and other biologics, in particular tralokinumab, are significantly better than traditional options in treating atopic dermatitis.
Though dupilumab enjoys broad indications as it is vastly used, patients who are insensitive to IL-4/13 inhibition may present a potential scenario for tralokinumab.
More studies and head-to-head trials are required to understand the benefits and risks of these biologics comprehensively.
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