Raj Chovatiya, MD, PhD

Starting systemic-ready patients with uncontrolled atopic dermatitis on systemic therapy, often a biologic, matters more than which agent comes first.

Comparing IL-13–targeting biologics means weighing trial design, populations, outcomes, and safety, then putting it in real-world terms.

Oral targeted agents, multispecific antibodies, and unconventional targets lead the atopic dermatitis pipeline.

 who remain uncontrolled on topical therapy, getting them onto systemic treatment matters more than which biologic a clinician selects first, according to Raj Chovatiya, MD, PhD, associate professor at Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology and Immunology Research in Chicago, Illinois.

Atopic Dermatitis Biologic Selection, With Raj Chovatiya, MD, PhD

2026 Fall Clinical Dermatology Conference

 in Las Vegas, Nevada, where he joined April W. Armstrong, MD, MPH, and Elizabeth (Lisa) A. Swanson, MD, for a satellite symposium titled “Better Biologic Decision-Making for Moderate-to-Severe Atopic Dermatitis: An Interactive Expert Exchange.”

 The session addressed the current biologic landscape in atopic dermatitis and how clinicians can make treatment decisions using the available evidence.

How Should Clinicians Approach Biologic Selection in Atopic Dermatitis?

Chovatiya’s first message centered on action over perfection. Clinicians may have many valid reasons for choosing one biologic over another, but he emphasized no wrong answer exists as long as a patient ready for systemic therapy is started on one. For many of these patients, the appropriate next step will be a biologic, and helping them move past persistent disease on topicals is a meaningful clinical gain.

How Do the IL-13–Targeting Biologics Compare?

His second point focused on interpreting the evidence behind current options. Clinicians now have more biologic choices in atopic dermatitis than ever before, which can make selection difficult on paper, particularly among agents acting on interleukin (IL)-13 signaling: dupilumab (Dupixent), tralokinumab (Adbry), and lebrikizumab (Ebglyss). Dupilumab blocks the shared IL-4 receptor alpha subunit, inhibiting both IL-4 and IL-13 signaling, while tralokinumab and lebrikizumab target IL-13 directly.

Without comprehensive head-to-head data, Chovatiya stressed the importance of comparing these agents directly where possible and indirectly otherwise, with attention to differences in trial design, patient populations, outcomes of interest, and safety. He also underscored the need to translate those comparisons into real-world terms, equipping both clinician and patient to reach the best possible treatment choice.

What Emerging Therapies Are on the Horizon for Atopic Dermatitis?

Therapeutic innovation in atopic dermatitis has not slowed over the past decade, Chovatiya noted, pointing to late-breaking presentations at the European Academy of Dermatology and Venereology (EADV) Congress 2026, held September 30 to October 3 in Vienna, Austria.<sup>2</sup> He highlighted 3 themes shaping the field.

The first is convenience, with a range of oral molecules designed to engage well-validated targets and deliver biologic-like efficacy as a daily oral medication. The second is raising the efficacy ceiling through multispecific antibodies, including bispecific and trispecific agents combining established and novel targets in a single therapy to safely and effectively improve treatment response.

The third theme involves targets well outside the conventional atopic dermatitis framework. Although these pathways may not yet be household names, Chovatiya suggested they could allow clinicians to safely and effectively treat more patients and potentially change the course of disease.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Chovatiya previously reported serving as an adviser, consultant, speaker, and/or investigator for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Argenx, ASLAN Pharmaceuticals, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, FIDE, Formation Bio, Galderma, Genentech, GSK, Incyte, LEO Pharma, L’Oréal, Nektar Therapeutics, Novartis, Opsidio, Pfizer Inc., Regeneron, RAPT, Sanofi, Sitryx, and UCB.

Armstrong AW, Chovatiya R, Swanson EA. Satellite symposium: better biologic decision-making for moderate-to-severe atopic dermatitis: an interactive expert exchange. Presented at: Fall Clinical Dermatology Conference 2026; October 8-11, 2026; Las Vegas, NV.

EADV Congress 2026. European Academy of Dermatology and Venereology. September 30-October 3, 2026. Vienna, Austria.

Videos

Raj Chovatiya, MD, PhD, explains how to approach biologic selection in atopic dermatitis and previews oral, multispecific, and novel-target therapies.

Credit: Rosalind Franklin University Chicago Medical School

Chovatiya said the priority in moderate to severe atopic dermatitis is moving patients who are uncontrolled on topicals onto a systemic therapy, often a biologic.

He said choosing among dupilumab, tralokinumab and lebrikizumab means weighing differences in trial design, patient populations, outcomes and safety.

Remibrutinib is now the first FDA-approved treatment for symptomatic dermographism, which gives clinicians an on-label option for an inducible urticaria they have largely treated off-label.

 now select from several biologics targeting IL-13 signaling, including dupilumab, tralokinumab, and lebrikizumab. With limited head-to-head data, differences in study design, patient populations, outcome measures, and safety reporting complicate both indirect comparisons and shared decision-making with patients.

The pipeline continues to widen beyond injectable monotherapy. Investigational strategies include daily oral small molecules aiming for biologic-level efficacy, bispecific and trispecific antibodies designed to raise the efficacy ceiling, and targets outside conventional atopic dermatitis pathways.

Advances in urticaria have arrived on a parallel track. On October 7, 2026, the 

 approved remibrutinib (Rhapsido; Novartis), an oral Bruton's tyrosine kinase inhibitor, for adults with symptomatic dermographism inadequately controlled by H1 antihistamines.¹ The agency first approved remibrutinib for chronic spontaneous urticaria on September 30, 2025.²

Novartis describes symptomatic dermographism as the most prevalent form of chronic inducible urticaria.¹ In the phase 3 RemIND trial, 29.3% (17/58) of patients receiving remibrutinib 25 mg twice daily achieved a complete Total Fric Score response at week 12 compared with 14.0% (8/57) receiving placebo (

 = .0229).³ Responses emerged as early as week 2.¹

The label expansion gives dermatologists an on-label option for a population historically managed with off-label therapy. Raj Chovatiya, MD, PhD, is an associate professor at Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology and Immunology Research in Chicago, Illinois. Chovatiya spoke with the 

 in Las Vegas about biologic selection, emerging therapeutic strategies, the remibrutinib approval, and his research on overlapping dermatologic and gastrointestinal comorbidities:

: What are the key takeaways from your session on biologic decision-making for moderate to severe atopic dermatitis?

At this year's Fall Clinical meeting, I had the opportunity to talk all about our biologic landscape for atopic dermatitis and, in particular, how we make treatment decisions based on the data available to us. If there are a couple of points I really want people to take away, number one: There really are no wrong answers as long as you're able to get your systemic therapy-ready patient on a systemic therapy. For many patients, that's going to be a biologic. There are a lot of different reasons why you might choose a biologic therapy, but as long as you can help your patient get past that hump of remaining uncontrolled on topicals, you're doing a good thing.

My second point is a very important one: Understand the data as it relates to our current biologic therapies. We have an embarrassment of riches, more so than we've ever had in the world of atopic dermatitis, and on paper, it can sometimes be very difficult to make choices, especially when talking to your patient about treatments like dupilumab, tralokinumab, and lebrikizumab. In the world of medications that can block IL-13, it's important to, one, understand how the data compare to one another, if not directly, then indirectly, particularly in the way of differences in trial designs, patient populations, different types of outcomes of interest, and safety, and two, really try to find a way to easily translate that into the real world to ultimately equip you and your patient to make the best treatment choice possible.

: Coming off EADV 2026, which updates in atopic dermatitis or other inflammatory diseases are you watching this year and next?

In the world of atopic dermatitis, there's a lot of therapeutic innovation continuing to happen. It really hasn't slowed down in the last 10 years, and at EADV 2026 this year in Vienna, we had a number of late-breaking and cutting-edge talks that were really designed to give us a lot of hope for what's happening in the future of this disease state. I'll focus on a few ideas that I think are really important to where we're at in atopic dermatitis.

One is the idea of: Can we make for a more convenient patient experience when it comes to thinking about treatment? We have a whole host of oral molecules that are trying to target well-validated targets to ultimately allow our patients to achieve biologic-like efficacy in the form of a daily oral medication.

Another big theme has been trying to raise the efficacy ceiling. If we combine targets that we do know with ones that we don't know and put them all together in a single biologic therapy, might we be able to safely and effectively increase treatment response in our patients? This is the theme of multispecific antibodies, i.e., bispecific and trispecific antibodies, which we've paid very close attention to over the last few years.

Finally, theme number 3: What about targets that are well off the beaten path, that don't necessarily have anything to do with atopic dermatitis at the forefront of our minds, but may in fact be a way that we can safely and effectively treat even more patients? This is the other big theme that continues to loom as we start to think outside the box and look at various treatment targets that may not necessarily be household names but potentially offer us a chance to really change the course of disease.

: Remibrutinib was just approved for symptomatic dermographism. What might this approval mean for clinicians and their patients?

 This is some exciting news breaking in 2026 before we make our way deep into the fall. Remibrutinib, a Bruton's tyrosine kinase, or BTK, inhibitor, has really been game-changing for us in the world of chronic spontaneous urticaria. Now, our latest update comes from the world of inducible forms of urticaria, essentially the whole host of other chronic urticarial diseases where, based on outside influences and clear triggers, urticaria can happen.

Symptomatic dermatographism is the newest indication for us. Whenever you've spent time in the doctor's office tracing with a little bit of pressure on somebody's back and noticing that, indeed, urticaria can form, that's what we're talking about. For many folks in the world of dermatology treatment, there's been a lot of off-label use of therapies, and this is a really exciting movement for us to have an on-label indication for what can be an extremely uncomfortable and chronic issue for a lot of our patients dealing with chronic urticaria. I'd say this is probably one of several more indications to come in the life of remibrutinib, and ultimately, a really exciting piece of news that I'm happy I can use to help my patients.

: What research are you currently working on that you would like to highlight for colleagues?

In the world of research, there are oftentimes a lot of things I'm working on with various members of my group, fellows, and students, and things that really strike our interest in the world of dermatology. I could spend another hour catching you up on everything I'm interested in, but one area of research that has really caught a lot of our attention is trying to better understand comorbid burden as it relates to diseases where we oftentimes expect there to be some degree of overlap, as well as some where there isn't quite so much.

One of the things that's been very interesting to me, as the husband of a very successful and smart gastroenterologist, is understanding the overlap between dermatologic disease and gastroenterologic disease. Jointly, we've been working together to better understand some of the overlapping comorbid burden as it relates to both hepatic disease and gastrointestinal disease compared with some of the disease states we think about all the time, both the more common associations, when we think about psoriasis and hidradenitis suppurativa, as well as the less common associations, like vitiligo. More results to follow, so stay tuned.

Novartis. Novartis Rhapsido (remibrutinib) receives FDA approval as first treatment for symptomatic dermographism (SD), expanding its use beyond chronic spontaneous urticaria (CSU). Published October 7, 2026. Accessed October 11, 2026. 

https://www.novartis.com/us-en/news/media-releases/novartis-rhapsido-remibrutinib-receives-fda-approval-first-treatment-symptomatic-dermographism-sd-expanding-its-use-beyond-chronic-spontaneous-urticaria-csu

Novartis. Novartis receives FDA approval for Rhapsido (remibrutinib), the only oral targeted BTKi treatment for chronic spontaneous urticaria (CSU). Published September 30, 2025. Accessed October 11, 2026. 

https://www.novartis.com/us-en/news/media-releases/novartis-receives-fda-approval-rhapsido-remibrutinib-only-oral-targeted-btki-treatment-chronic-spontaneous-urticaria-csu

Johnson V. Remibrutinib receives FDA approval for symptomatic dermographism. HCPLive. Published October 7, 2026. Accessed October 11, 2026. 

https://www.hcplive.com/view/remibrutinib-receives-fda-approval-symptomatic-dermographism

Articles

Raj Chovatiya, MD, PhD, discusses biologic choice in atopic dermatitis, pipeline strategies, and remibrutinib’s approval for symptomatic dermographism.

Atopic Dermatitis Pipeline and Remibrutinib Approval for Dermographism

Takeda has reported site-specific responses among patients with 

 in the scalp, nails, palms and soles with zasocitinib, an investigational once-daily oral tyrosine kinase 2 (TYK2) inhibitor, in 2 phase 3 trials.¹

LATITUDE PsO 3001 and 3002 enrolled 693 and 1,108 adults with moderate-to-severe plaque psoriasis and compared zasocitinib with placebo and apremilast.¹ The 

 has accepted the New Drug Application under Priority Review, with a target action date slated for the first quarter of 2027, Takeda announced in September 2026.¹

At Week 16, 77% of those in 3001 and 74% in 3002 attained scalp-specific Physician Global Assessment (ssPGA) scores of 0 or 1, compared with 7% and 13% with placebo (

 < .001).¹˒² The Nail Psoriasis Severity Index (NAPSI) least-squares mean shift from the point of baseline was -7.1 in 3001 and -8.6 in 3002 (

 < .001 vs placebo).¹˒² Hands and/or feet Physician Global Assessment (hfPGA) scores of 0 or 1 occurred in 71% and 69% with zasocitinib, compared with 22% and 10% with placebo, in a secondary endpoint not controlled for multiplicity.¹

In 3002, 17% of patients reached Psoriasis Area and Severity Index 75 (PASI 75) at week 4 with zasocitinib, compared with 4% with placebo (

 < .001).¹ Takeda also reported skin clearance increasing through weeks 24 and 52, with no new safety signals.¹ The open-label LATITUDE PsO 3003 study, which enrolled about 2,100 participants, is evaluating long-term safety, tolerability and efficacy.¹

Raj Chovatiya, MD, PhD, a board-certified dermatologist and associate professor at Rosalind Franklin University Chicago Medical School, also founded and directs the Center for Medical Dermatology + Immunology Research in Chicago. In the following Q&A interview discussion, Chovatiya shares his perspective on special site involvement, speed of response and once-daily dosing with zasocitinib:

HCPLive: Why are the scalp, nails, palms and soles particularly challenging areas from both a treatment and cosmetic perspective?

 In psoriasis, we talk about special sites, and what really makes them special is, number one, they seem to potentially be slightly more difficult in terms of drug penetration. So we've always wondered if you had the right type of targeting agent, could you potentially hit better efficacy? And two, individuals who may have involvement of these areas can have relatively limited extent, but they oftentimes feel the same degree of burden as somebody who might have more traditional plaque psoriasis from head to toe.

If you think about your scalp being a part of the head and neck region that you have to go about every single day, talking to folks, having people looking at you, when you think about your hands, shaking hands, going out there doing your work and day-to-day functioning, thinking about your nails, even thinking about the genital region as well, all of these are special in the sense that they're often associated with undue burden for our patients. So it's particularly exciting, beyond some of the top-line data we've seen, that zasocitinib can result in a high degree of clearance in these areas too. And I think the scientific question that's very interesting is, now with more and more small-molecule options coming about in psoriasis, might there be a pathogenic reason why we see efficacy there compared to biologic therapies?

That question isn't really known, but we wonder if there's going to be a root reason why we could potentially have better effect there, or even a target standpoint. One of the theoretical ideas with TYK2 inhibition has been, given its role in other elements of the immune system signaling pathway, could it potentially result in some different degrees of clearance in some of these sites too? And I think that's really what the next generation of research is setting us up for, as long as we have newer therapeutic options.

: With about 70% of patients achieving clear or almost clear skin at week 16, how quickly might patients see a visible difference?

 One of the nice things about the data cuts we've seen from zasocitinib so far is that it definitely doesn't appear to be slow. I think our patients are going to start seeing meaningful differences pretty early, and it seems like many of these results also continue to improve, potentially even beyond the primary period of our examination as we enter longer phases of this study. Compared to the way we've felt about oral therapies prior, and particularly in the case of our more first-generation TYK2 inhibitors, I think we're going to be able to have a reasonable discussion and balance of speed, effectiveness, as well as long-term effectiveness and durability overall.

: How might a once-daily oral option like zasocitinib change the conversation around managing visible psoriasis?

I think if somebody can get over the idea of having to use something beyond a cream, then a once-daily option you can take orally resonates with the way we've all thought about medications all of our lives. Whether you think about antibiotics or analgesics or cold medication, they're all essentially once-daily medications that you take for varying degrees of time. In this case, this one would be more of a chronic medication. But I think the idea of something you just have to take once a day as a pill continues to be an important piece in the psyche of just human beings when thinking about medications overall.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

Takeda Pharmaceutical Company Limited. U.S. FDA accepts new drug application under priority review for Takeda's zasocitinib in moderate-to-severe plaque psoriasis, with potential to redefine oral treatment expectations. Published September 14, 2026. Accessed September 21, 2026. 

https://www.takeda.com/newsroom/newsreleases/2026/fda-priority-review-zasocitinib-psoriasis/

Armstrong AW, et al. Zasocitinib, a once-daily oral TYK2 inhibitor, demonstrates efficacy at high impact sites in adults with moderate-to-severe plaque psoriasis: results from two randomized phase 3 trials (LATITUDE-PsO-3001 and 3002). Presented at: 2026 American Academy of Dermatology Innovation Academy; July 16, 2026; New York, NY.

Takeda’s investigational once-daily oral TYK2 inhibitor zasocitinib demonstrated robust special-site efficacy in phase 3 plaque psoriasis, with high rates of scalp clearance and meaningful improvements in nail disease, plus strong hands/feet responses. Onset appeared rapid, with early PASI 75 separation by week 4 and continued gains through weeks 24 and 52, without new safety signals. FDA accepted the NDA under Priority Review with an action date anticipated in Q1 2027. Long-term safety and durability are being assessed in a large open-label extension.

Raj Chovatiya, MD, PhD, on zasocitinib results in the scalp, nails, palms and soles, speed of response and once-daily oral dosing in psoriasis.

Q&A: Zasocitinib Response in the Scalp, Nails, Palms and Soles

 accepted a New Drug Application for zasocitinib (TAK-279), an investigational once-daily oral tyrosine kinase 2 (TYK2) inhibitor, for adult patients with moderate-to-severe plaque psoriasis, Takeda announced on September 14, 2026.¹ The application received Priority Review, with a Prescription Drug User Fee Act target action date in the first quarter of 2027.¹ Additionally, the European Medicines Agency accepted a marketing authorization application.¹

The filing followed the phase 3 LATITUDE PsO 3001 and 3002 analyses, which enrolled 693 and 1108 adults across 21 countries and compared zasocitinib with placebo and apremilast.¹ At Week 16, 71% of patients in 3001 and 69% in 3002 reached a static Physician Global Assessment (sPGA) score of 0 or 1 with zasocitinib (

 < .001 vs placebo).¹˒² Response rates were 32% and 30% with apremilast and 11% and 13% with placebo.¹˒²

Psoriasis Area and Severity Index (PASI) 75 rates were 76% in 3001 and 71% in 3002 with zasocitinib, compared with 37% and 33% with apremilast and 12% with placebo in both trials.¹˒² PASI 90 rates were 61% and 52% with zasocitinib, 17% and 16% with apremilast, and 5% and 4% with placebo.¹˒²

Takeda reported no new safety signals, with upper respiratory tract infection (10.1%), acne (6.5%) and nasopharyngitis (6.2%) as the most common adverse events across the 2 trials.¹ Raj Chovatiya, MD, PhD, is an associate professor at Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology + Immunology Research in Chicago. During this Q&A interview, Chovatiya discussed where zasocitinib may fit in the psoriasis treatment algorithm and what high clearance rates could mean for patients":

: Where do you see zasocitinib fitting into the psoriasis treatment algorithm relative to biologics and other oral options like apremilast?

It's an exciting announcement, perhaps one we should have been expecting based on the data we've seen. Your question about whether we need more in psoriasis is a good one, because we have more than a dozen options, obviously a number of biologics. Orals have now started to creep into the landscape beyond even apremilast. We had deucravacitinib a few years ago, which had its own hits and misses, and of course, most recently, icotrokinra as well. When thinking about where treatment options fit, we still continue to struggle with making sure all of our patients with moderate to severe psoriasis are on an appropriate, targeted, advanced therapeutic.

So point number 1, whether it's an injectable or an oral, is that getting somebody to the next step of treatment beyond topicals is key. That is one great place where you're going to see a medication like zasocitinib fit. 2, the debate about oral versus biologic has long slanted toward biologics if it's purely based on efficacy. Now, as we're starting to see newer biologic therapies, both small peptides and next-generation TYK2 inhibitors, there's at least more of a comparative similarity between them in terms of how many patients can get relatively clear. So at least you can offer somebody a different route or option if that's what fits in with their life.

And 3, orals have a certain innate sense in a lot of folks that these medications are very similar to something I've used before. If I'm particularly naive to taking systemic medications for most conditions, this might be a way for me to dip my toe in. So what we hope is that medications like zasocitinib may make more individuals who are just entering the systemic-ready phase, or who have more limited areas that are really burdensome, ready to take a therapy.

: How meaningful could high rates of clear or almost clear skin with zasocitinib be from an aesthetic and quality-of-life perspective?

 Immense. If patients were on the fence before, and a lot of it came down to the idea of having to use a biologic therapy, then the idea of an oral treatment that can offer patients a chance to essentially clear up their skin, get their life back, go about their day-to-day function, and perhaps believe they can be their best aesthetic and cosmetic self, that potential difference you can make in a patient's life is huge. So I think a medication like zasocitinib, with some of those high clearance rates, really speaks to what could be possible and the large gap that still remains in terms of our untreated patient population.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Chovatiya previously reported serving as an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Argenx, ASLAN Pharmaceuticals, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, FIDE, Formation Bio, Galderma, Genentech, GSK, Incyte, LEO Pharma, L’Oréal, Nektar Therapeutics, Novartis, Opsidio, Pfizer Inc., Regeneron, RAPT, Sanofi, Sitryx, and UCB.

Gooderham M, et al. Once-daily oral zasocitinib demonstrates rapid and reproducible skin clearance with a consistent safety profile in moderate-to-severe plaque psoriasis: results from two randomized phase 3 trials (LATITUDE-PsO-3001 and 3002). Presented at: 2026 American Academy of Dermatology Innovation Academy; July 16, 2026; New York, NY.

FDA accepted and granted Priority Review to the NDA for zasocitinib (TAK-279), a once-daily oral TYK2 inhibitor, for adults with moderate-to-severe plaque psoriasis, with a PDUFA target in Q1 2027; EMA also accepted the MAA. In phase 3 LATITUDE-PsO 3001/3002 (n=693/1108), zasocitinib significantly outperformed placebo and apremilast on sPGA 0/1 and PASI 75/90 at Week 16. No new safety signals emerged; URTI, acne, and nasopharyngitis were most common.

In this Q&A, Raj Chovatiya, MD, PhD, discusses where zasocitinib fits in the psoriasis treatment algorithm and what high clearance rates mean for patients.