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Raj Chovatiya, MD, PhD, explains how to approach biologic selection in atopic dermatitis and previews oral, multispecific, and novel-target therapies.
For patients with atopic dermatitis 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.
Chovatiya spoke with HCPLive during the 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.”1 The session addressed the current biologic landscape in atopic dermatitis and how clinicians can make treatment decisions using the available evidence.
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.
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.
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.
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