Updated AAD Guidelines on AD in Adults Back Use of Biologics, JAK Inhibitors

Guideline author Dr. Aaron Drucker discusses the updates with DermWire.

Updated American Academy of Dermatology (AAD) guidelines on systemic treatment of atopic dermatitis (AD) in adults strongly back the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib.

“When the last guidelines were published in 2014, only non-targeted, off-label systemic medications were available,” says Aaron Drucker, MD, an associate professor in the Division of Dermatology at the University of Toronto and a co-author of the guidelines. “We now have two biologics and two JAK inhibitors approved, backed by large Phase 3 clinical trials, and we have substantial evidence to recommend these medications to treat atopic dermatitis.”

The new guidelines appear in the Nov. 7, 2023 issue of the Journal of the American Academy of Dermatology.

The updated guidelines include strong recommendations for the use of dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib and conditional recommendations for using phototherapy, azathioprine, cyclosporine, methotrexate, and mycophenolate. In addition, the guidelines do not recommend treating atopic dermatitis in adults with systemic corticosteroids.

These guidelines “give dermatologists a trustworthy source of evidence-based guidance to treat patients with more severe or refractory atopic dermatitis,” he tells DermWire. “ We evaluated the evidence using the GRADE approach, so dermatologists and others can transparently assess the different treatment options.”

The guidelines are not meant to be prescriptive or mandate how a physician should treat individual patients. “Physicians can incorporate the guidelines into their shared-decision making process with patients to create treatment plans that work for them.”