Dupilumab (brand name Dupixent), Tralokinumab (brand name Adraltza) and Lebrikizumab (brand name Ebglyss) are medications from the class of biologics that can be used in the treatment of atopic dermatitis.

Dupilumab, Tralokinumab and Lebrikizumab are prescribed for the treatment of children and adult patients with moderate to severe atopic dermatitis who have not responded adequately to topical medications or have not tolerated them.

In this case, Dupilumab can be prescribed for children with severe atopic dermatitis starting from the age of 6 months.

What are biologics? How do they work in the treatment of atopic dermatitis?

Biologics are specific antibodies produced biotechnologically. In 2017, the first biologic for the treatment of atopic dermatitis was approved. Biologics specifically target the inflammatory processes underlying the symptoms of atopic dermatitis, helping to relieve itching and improve skin appearance. They act more selectively than conventional medications and do not suppress the entire immune system.

How do Dupilumab, Tralokinumab and Lebrikizumab work?

The active ingredient Dupilumab specifically targets interleukins 4 and 13. Tralokinumab and Lebrikizumab are antibodies that target interleukin 13. These interleukins play a crucial role in the development of the inflammatory response responsible for atopic dermatitis. By inhibiting these interleukins, Dupilumab, Tralokinumab and Lebrikizumab can reduce the inflammatory response and alleviate symptoms.

What side effects can biologics have?

The most common side effects of Dupilumab and Lebrikizumab include reactions at the injection site. The most common side effect of Tralokinumab was infections of the upper respiratory tract.

Additionally, rarely the following accompanying effects may occur:

• Conjunctivitis

• Headaches

• Oral herpes

  
  

  
  

Who is it not suitable for?

Dupilumab, Tralokinumab and Lebrikizumab should not be used if your child has a hypersensitivity or allergy to the active ingredient. In the event of a hypersensitivity reaction, treatment must be immediately discontinued.

Dupilumab is approved for children with severe atopic dermatitis from the age of 6 months. Tralokinumab and Lebrikizumab are approved for children aged 12 and older with moderate to severe atopic dermatitis.

What are alternatives to biologics?

Alternative treatment options include topical therapies with glucocorticoids or calcineurin inhibitors, phototherapeutic treatments or JAK inhibitors such as Abrocitinib. Other systemic therapies such as Cyclosporin, Methotrexate, or Azathioprine are still used in exceptional cases in children due to the new biologics or JAK inhibitors. The choice of treatment should be discussed individually with a dermatologist or paediatrician.

Don't forget!

Even during treatment with one of the biologics, children's skin requires regular basic care that nourishes and hydrates the skin. This care should definitely be continued.

Sources

1. AWMF (2024). S3 Guidelines Atopic Dermatitis.

2. Wollenberg A et al. (2022). European guideline on atopic eczema – Part II: Non‐systemic and systemic treatments.