Atopic dermatitis (AD) is a chronic type 2 inflammatory disease driven by Th2/Th22 immune dysregulation and epidermal barrier dysfunction. Moderate-to-severe AD has a rapidly expanding armamentarium of targeted biologics and oral JAK inhibitors, with treatment selection increasingly shaped by comparative real-world safety data.

A prospective multicentre registry study in 1,793 AD patients demonstrated that JAK inhibitors carry higher infection rates (58–65 per 100 patient-years) versus IL-4/IL-13 pathway inhibitors (14–22 per 100 patient-years), with herpes infections comprising 24.6% of events and hazard ratios of 4.0–4.2 for studied JAK inhibitors versus IL-4/IL-13 dual inhibitor. These real-world data complement phase 3 efficacy evidence to guide risk-stratified therapy selection, particularly in patients with prior infection history, cardiovascular risk, or immunocompromise. Treat-to-target approaches, comorbidity profiling, and age-appropriate prescribing remain central to optimizing outcomes across pediatric and adult populations.

Dermatologists, allergists, and clinicians managing moderate-to-severe AD will benefit from peer discussion of biologic versus JAK inhibitor selection, real-world safety data, risk-stratified prescribing, and monitoring frameworks.

How do real-world infection risk data inform your selection between IL-4/IL-13-targeted biologics and JAK inhibitors in moderate-to-severe AD, particularly in patients with prior infection history or immunocompromising comorbidities? What treat-to-target parameters and monitoring intervals do you apply for patients on targeted systemic AD therapy, and how do you approach switching in inadequate responders?