In this video blog, Dr. James Song summarizes his lecture, Update on AD Therapeutics on November 8, 2024, at the 5th Annual Elevate-Derm West Conference at the Westin Kierland Resort in Scottsdale, AZ.

In this video

Speaking with dermatology PA Buchi Nita, Dr. Song frames the three approved AD biologics as "much more similar than they are different" — all effective, extremely safe, and all causing some conjunctivitis. Dupilumab inhibits both IL-4 and IL-13 at the receptor, while lebrikizumab and tralokinumab block IL-13 directly, with lebrikizumab having the highest binding affinity and lowest dissociation rate. Practically, age is the biggest differentiator (dupilumab down to six months versus 12 and up), along with dosing intervals and dupilumab's five additional indications. He suggests the more interesting question isn't which to start, but which to switch to when the first doesn't work.

He describes OX40 and OX40-ligand inhibitors — rocatinlimab and amlitelimab — as a class targeting co-stimulatory immune checkpoint molecules across TH2, TH1, TH17, and TH22 lineages, fitting AD's heterogeneity and potentially inducing remission by hitting memory T cells, with patients staying clear for months off drug in phase 2 data. On the emerging front, he covers topical ruxolitinib (with pediatric data down to age two), delgocitinib for chronic hand eczema (beating alitretinoin head-to-head), roflumilase cream with a clear-then-twice-weekly maintenance design, and a tapinarof-class 1% cream keeping patients nearly clear for close to 80 days off drug.

  • The three AD biologics are more alike than different — all effective, very safe, and all associated with some conjunctivitis; age, dosing intervals, and additional indications drive the practical choice.
  • Dupilumab blocks IL-4 and IL-13 at the receptor; lebrikizumab and tralokinumab target IL-13 directly, with lebrikizumab showing the highest binding affinity and lowest dissociation rate.
  • OX40/OX40-ligand inhibitors (rocatinlimab, amlitelimab) target multiple T-cell lineages and memory T cells, offering broader coverage of heterogeneous AD and durable clearance off therapy.
  • Topical ruxolitinib 1.5% has been one of Dr. Song's most effective therapies; pediatric data (ages 2–11) look consistent with older patients, pending younger-age approval.
  • Emerging topicals — delgocitinib (beat alitretinoin for chronic hand eczema), roflumilase 0.15% cream, and a tapinarof-class 1% cream (clear for ~80 days off drug) — expand nonsteroidal options.