ABCs of Biologics in Pediatric Eczema: An Updated Review on the Safety and Efficacy of Systemic Treatments for Pediatric Atopic Dermatitis and Future Directions

Expansion of systemic therapies has improved atopic dermatitis (AD) management in pediatric cohorts, however guidelines for use of these medications in children remain limited. This review aims to guide decision-making for selection and substitution of systemic therapies as well as anticipation of potential adverse effects for pediatric AD patients.

Currently, high-dose abrocitinib and any-dose upadacitinib exhibit the best clinical outcomes followed by dupilumab. Administration of scheduled live vaccines in dupilumab-treated children outweighs risks of deferred immunization, however vaccine safety and efficacy in dupilumab and future systemic AD therapies should be included in clinical trials.

Dupilumab has the broadest age-approval and best safety-efficacy and is thus the best first-choice systemic option for pediatric AD. Risks of dupilumab use include provisional guidance for administration of scheduled live vaccines in children and conjunctivitis, which may be mitigated with topical treatments or switching to an IL-13 inhibiting MAB such as tralokinumab or lebrikizumab.