Clinical Report: Global Approaches and Expert Recommendations for Starting Biologics in Atopic Dermatitis
Overview
The AMAZE project examined real-world approaches to initiating and monitoring biologics for moderate-to-severe atopic dermatitis (AD), using a literature review, an international survey, and regional expert meetings. Responses from 150 dermatologists showed substantial variation in treatment transitions, follow-up scheduling, and anticipated treatment duration; experts identified patient-centered goals, individualized transition plans, response assessment at approximately 12–16 weeks, and continued topical therapy as practical considerations.
Background
AD is a chronic, relapsing inflammatory skin disease associated with eczematous lesions, severe pruritus, and reduced quality of life. Topical treatments are generally used for mild-to-moderate disease, but may not adequately control more extensive disease. Conventional systemic immunosuppressives are used for moderate-to-severe AD, although their use may be limited by safety and tolerability concerns, laboratory-monitoring requirements, and limited capacity to achieve substantial skin clearance and itch improvement. Despite treatment guidelines and clinical-trial evidence for targeted systemic therapies, practical guidance on initiating biologics—particularly transitions from conventional systemic treatments—has remained limited.
Data Highlights
Measure or practice area
Finding reported
Dermatologist survey
150 dermatologists worldwide responded.
Biologic transition strategies
Approaches varied and included overlapping therapy, direct switches, and washout periods.
Other areas of variation
Follow-up scheduling and anticipated treatment duration differed among clinicians.
Expert response assessment interval
Approximately 12–16 weeks.
Key Findings
The AMAZE project used a mixed-methods design incorporating a narrative literature review, online survey, regional expert meetings, and global steering committee oversight.
Survey responses from 150 dermatologists worldwide indicated considerable heterogeneity in biologic initiation and management practices.
Clinicians reported varied approaches to switching from conventional systemic therapies, including overlap, direct switching, and washout periods.
Follow-up timing and expectations for treatment duration also varied across respondents.
Expert opinion identified defining patient-centered treatment goals and tailoring transition strategies as best practices for biologic initiation.
Experts advised assessing response at suitable intervals, approximately 12–16 weeks, and continuing background topical therapy to address flares and support sustained disease control.
Clinical Implications
The project describes variation in routine biologic initiation and management and offers expert-informed considerations for treatment goals, therapy transitions, response assessment, and background topical treatment. The source does not establish a single transition strategy; it reports that approaches should be tailored to the treatment switch and clinical context.
Conclusion
AMAZE documents substantial international variation in how dermatologists initiate and manage biologics for moderate-to-severe AD. Its expert recommendations focus on individualized transitions, patient-centered goals, response review at approximately 12–16 weeks, and continued topical therapy.
by April W. Armstrong, Hyun Jung Kim, Andrew E. Pink, Joe Gorelick, Mariateresa Rossi, Magdalena Trzeciak, Mette Deleuran, Saeko Nakajima, Vimal H. Prajapati
