At the 2025 American Academy of Dermatology (AAD) Annual Meeting, key updates in atopic dermatitis (AD) included real-world data on abrocitinib, long-term data on lebrikizumab, and discussions on the relative efficacy of biologics. Despite the effectiveness of JAK inhibitors, uptake remains low due to safety concerns. Future innovations may continue to impact evolving treatment strategies.

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Following these presentations, featured expert Peter A. Lio, MD, was interviewed by Conference Reporter Medical Director Lauren Weinand, MD. Clinical perspectives from Dr Lio on these findings are presented here.

There was a lot of discussion about AD at the 2025 AAD Annual Meeting, including data on JAK inhibitors and biologics. For example, updated real-world data from China on the JAK inhibitor abrocitinib were presented at the meeting. This study involved 314 patients with AD from approximately 40 cities. We have limited real-world data in AD, and even fewer real-world data from China. It was fascinating to see the results of abrocitinib treatment in a different patient population. These real-world data provide additional evidence that this JAK inhibitor is quite effective and is fairly safe.

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The hardest thing right now is getting clinicians comfortable using the JAK inhibitors. Many feel that there are too many risks associated with their use, given the US Food and Drug Administration (FDA) boxed warning about the risks of blood clot, stroke, heart attack, death, malignancy, and infection. In addition, laboratory monitoring must be performed in patients on JAK inhibitors, which does not have to be done with any of the biologics for AD.

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As for the biologics, 3-year data on lebrikizumab from a study by Eric Simpson, MD, MCR, and colleagues were also presented at the 2025 AAD Annual Meeting. Additionally, I presented a poster on patients with AD receiving Medicaid who were not receiving the level of care they needed, particularly in terms of having a high discontinuation rate of biologic therapy. Finally, pediatric data on nemolizumab and other emerging immunomodulatory treatments were reported at the meeting as part of a systematic review.

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Nemolizumab is currently FDA approved for patients with AD aged 12 years or older, but data are now available on nemolizumab for patients between 6 and 12 years of age, and it is being evaluated in children as young as 2 years of age, as well. It works differently from dupilumab, tralokinumab, and lebrikizumab, which are all very similar to each other because they all interfere with the IL-13 pathway. Nemolizumab targets IL-31, which is thought to be the master itch cytokine. It is a completely different pathway, and, while mostly targeting itch, it also has an effect on inflammation and the skin barrier. I am finding that treatment with nemolizumab is much more hit or miss in terms of efficacy for an individual patient, but when it hits, the effects are rapid. In fact, some people may feel better within days of getting the injection, which can be a game changer.

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A recent Bayesian network meta-analysis reported the efficacy of tralokinumab as being substantially below that of dupilumab. I think that lebrikizumab is on par with dupilumab and may be even slightly better. Most of my patients on lebrikizumab have already been on dupilumab, and they may be getting a bit more benefit from the lebrikizumab therapy.

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As unconventional as it may seem, I have occasionally “doubled up” by prescribing simultaneous treatment with nemolizumab and lebrikizumab to target multiple pathways in select patients. Many of these individuals have already failed numerous therapies, including dupilumab and, often, JAK inhibitors, and some have shown meaningful benefit from this combination strategy. I also treat a subset of patients with overlapping AD and psoriasis, in whom I have used combinations such as guselkumab or risankizumab (both IL-23 inhibitors) alongside dupilumab. It is nearly impossible to obtain insurance approval for these high-cost regimens, and this remains a major barrier.

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That said, this kind of multimodal targeting underscores the rationale behind emerging bsAb therapies, especially those directed at both the IL-4 and IL-31 pathways. These investigational agents promise the benefit of dual inhibition in a single therapy, and I anticipate that we will be hearing much more about them in the coming years.