Biologics in Early Childhood and Adolescence – Daphne Bakker (The Netherlands)

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases, affecting up to 20% of the pediatric population. Although topical corticosteroids are the first-line treatment, they often prove ineffective in curbing moderate-to-severe AD, where systemic treatments are required. An improved understanding of AD pathogenesis has recently led to the development of the first targeted therapies: Dupilumab, an interleukin (IL)-4 receptor-α monoclonal antibody inhibiting IL-4 and IL-13 signalling, is approved for the treatment of moderate-to-severe AD patients as young as 6 months in Europe and the United States. Tralokinumab, a biologic directly inhibiting IL-13 cytokine, is currently approved for use in patients aged 12 years or older in Europe. Lebrikizumab, which neutralizes IL-13, has completed adolescent trials and will soon be submitted for approval.

Biologic treatment significantly improved disease severity and disease-associated symptoms in pediatric patients with moderate-to-severe AD in clinical trials as well as in daily practice, and the safety profile is superior to that of immunosuppressant alternatives. Ocular surface disease is clinically the most significant side effect in all three biologics, and additional adverse events have been described since the commercial availability of dupilumab (including alopecia areata and psoriasiform eruptions). The availability of these first biologics for pediatric AD has shifted the treatment paradigm from requiring broad immunosuppressants to more targeted and safer alternatives. However, these introductions come along with new challenges.