Navigating Treatment Sequencing and Defining Failure in Moderate-to-Severe Atopic Dermatitis

In 'Navigating Treatment Sequencing and Defining Failure in Moderate-to-Severe Atopic Dermatitis,' the expert dermatologist examined the following critical questions:

Do you think the absence of strong head-to-head guidance is a primary driver of the biologic cycling with interleukin-targeting therapies that we're seeing?

Walk us through how AHEAD recommendations have shaped your approach to patient assessment and treatment sequencing. Are these recommendations being adopted broadly, or are they more aspirational at this stage?

Which elements do you see as the most practical?

What do you see as the main limitations of the AHEAD recommendations and should they be updated in the future?

When you're evaluating a patient with moderate-to-severe atopic dermatitis (AD), how do you determine they've failed conventional therapy and are ready to move to an advanced treatment? What does that threshold look like in practice?

Angela Lamb discussed how the lack of robust head-to-head comparative data across interleukin-targeting biologics contributes to biologic cycling, noting that without clear guidance on which agent best matches a given patient's immunologic drivers, clinician decision-making often relies on phenotype and clinical experience rather than predictive data. Dr. Lamb reflected on how AHEAD recommendations have provided a useful framework for aligning patient assessment with treatment sequencing, though she noted that broader adoption remains aspirational for many practices given the practical demands of routine clinical care. She also outlined how the threshold for transitioning to advanced therapy is determined not by a single metric but by a convergence of factors including body surface area involvement, degree of itch, sleep disruption, quality of life impairment, and failure to respond adequately to conventional treatments.

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, 'Advanced Treatments, Biologic Cycling, and Head-to-Head Data in Atopic Dermatitis,' the discussion continues on atopic dermatitis, highlighting the advanced therapies currently in use and how clinicians differentiate between available agents, the drivers and consequences of biologic cycling, and key findings from the LEVEL UP head-to-head trial comparing upadacitinib against dupilumab.