Advanced Treatments, Biologic Cycling, and Head-to-Head Data in Atopic Dermatitis

In this episode, 'Advanced Treatments, Biologic Cycling, and Head-to-Head Data in Atopic Dermatitis,' the expert dermatologist explored the following questions:

Which advanced treatments are you currently utilizing in your clinical practice and how do you differentiate between the available agents?

There's a significant amount of biologic cycling happening in atopic dermatitis (AD). From your perspective, what's driving that? And what are the real consequences for patients?

How do you counsel patients who have already cycled through one or more biologics?

How can cycling add to the individual and group-level costs?

Let's talk about the head-to-head trial data comparing the JAK1 inhibitor upadacitinib against dupilumab, the LEVEL UP study. What findings stood out to you, and how has that data changed conversations you're having with patients and with payers?

Angela Lamb discussed how advanced therapy selection — spanning interleukin-4 (IL-4), IL-13, and IL-31 inhibitors as well as oral Janus kinase (JAK) inhibitors — is guided by patient phenotype, age-based restrictions, disease severity, and whether the presentation is more itch-dominant or body surface area (BSA)-dominant rather than a one-size-fits-all approach. Dr. Lamb identified the lack of predictive biomarker data on individual patients' interleukin drivers as a primary contributor to biologic cycling, noting that without this information, clinicians often rely on clinical judgment and phenotype rather than objective guidance to select the optimal first-line agent. She also outlined the significant individual and systemic costs of cycling, including absenteeism, educational disruption for children, and the financial burden of expensive medications that may not be optimally matched to the patient, and noted that findings from the LEVEL UP head-to-head trial demonstrated that upadacitinib achieved superior rates of skin clearance and itch reduction compared with dupilumab across key endpoints, strengthening conversations with both patients and payers about the value of targeted therapy selection.

Throughout the conversation, the expert provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, 'Switching Data, JAK Inhibitor Options, and the Future of Atopic Dermatitis Treatment,' the discussion continues on atopic dermatitis, highlighting what the LEVEL UP switching data reveal for clinicians, how oral and topical JAK inhibitors differ and when each is most appropriate, what evidence would be most compelling for positioning advanced therapy earlier in the treatment algorithm, and which emerging pipeline agents are generating the most excitement.