Choosing Between Biologics and JAK Inhibitors for Atopic Dermatitis Patients

Atopic dermatitis is one of the most prevalent chronic inflammatory skin conditions globally, causing significant suffering through persistent itch, disrupted sleep, infection risk, and psychological burden. For patients who fail conventional topical therapies, a new generation of targeted systemic treatments has transformed care—but choosing among them requires nuanced clinical judgment.

This 2025 narrative review by Kamata, Sun, and Paller synthesizes available evidence on four approved biologics and three JAK inhibitors to help clinicians prioritize therapy for individual patients with moderate-to-severe AD. Rather than presenting new trial data, the authors integrate existing clinical evidence into a practical decision-making framework.

Biologics such as dupilumab (approved from 6 months of age) target upstream type 2 cytokine pathways, offering durable disease control and simultaneous management of atopic comorbidities like allergic asthma. Newer biologics—tralokinumab, lebrikizumab, and nemolizumab—expand options with distinct cytokine targets. JAK inhibitors (upadacitinib, abrocitinib, baricitinib) act downstream via the JAK-STAT pathway, providing faster onset of itch relief and inflammation control but carrying a more complex safety profile, including warnings around thrombosis and malignancy risk.

Age eligibility differs significantly: JAK inhibitors are approved from age 12 in the US, though baricitinib is approved from age 2 in some regions. Comorbidity profiles, patient preference for injectable versus oral routes, and individual risk factors all inform optimal selection.

The review underscores that no single agent suits all patients, and that shared decision-making—weighing speed of response, safety, comorbidities, and lifestyle—is essential. As the therapeutic landscape continues to expand, structured frameworks like this become increasingly valuable for both dermatologists and primary care providers managing AD.