TARGETED SYSTEMIC THERAPIES IN ATOPIC DERMATITIS A COMPARATIVE REVIEW OF BIOLOGICS AND JAK INHIBITORS

Abstract

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease characterized by eczematous lesions, intense pruritus, sleep disturbance, impaired quality of life, and substantial psychosocial burden. For patients with moderate-to-severe disease inadequately controlled by optimized topical therapy, targeted systemic therapies have transformed management. These therapies include biologic agents directed against type 2 inflammatory cytokine pathways and oral Janus kinase (JAK) inhibitors that suppress intracellular cytokine signaling. This narrative comparative review evaluates approved and guideline-supported targeted systemic therapies for AD, focusing on mechanism of action, efficacy, speed of response, safety, monitoring requirements, patient selection, and practical treatment decision-making. Biologics such as dupilumab, tralokinumab, lebrikizumab, and nemolizumab selectively target interleukin-mediated pathways and are generally positioned as durable long-term options with lower laboratory-monitoring burden. JAK inhibitors such as upadacitinib, abrocitinib, and baricitinib tend to offer rapid improvement in itch and skin signs but require careful risk stratification because of infection risk, laboratory abnormalities, and cardiovascular or thrombotic warnings. Evidence from pivotal trials, prescribing information, and contemporary guidelines supports individualized therapy selection based on disease severity, urgency of symptom control, comorbidities, age, route preference, monitoring feasibility, and patient values. Overall, biologics and JAK inhibitors should not be viewed as interchangeable agents but as complementary therapeutic classes.