NASHVILLE – At the 2025 Revolutionizing Atopic Dermatitis (RAD) Conference, held in NASHVILLE, Tennessee, RAJ CHOVATIYA, MD, PhD, MSCI, TEJESH PATEL, MD, and G. SCOTT DREW, DO, presented insights on dose flexibility in adult atopic dermatitis (AD).¹ The presentation underscored the importance of personalized treatment approaches to improve patient outcomes.

DR. CHOVATIYA, clinical associate professor at the rosalind Franklin University chicago Medical School and founder/director of the Center for medical Dermatology and Immunology Research in Chicago, discussed how both oral and biologic therapies can be adjusted based on disease control, patient lifestyle, and real-world treatment patterns. He drew upon clinical practice and trial data to illustrate how personalized dosing strategies can lead to better long-term results for adult AD patients.

Understanding Dose Flexibility in Atopic Dermatitis

Dose flexibility refers to the ability to adjust medication dosages and schedules to suit individual patient needs and circumstances. This approach is gaining traction in dermatology as clinicians recognize the variability of AD and the importance of patient-centered care.

“Patients oftentimes want their medications to fit around their life, especially based on their symptoms.”

According to DR. CHOVATIYA, “One of the things that we’ve learned is that in the real world, patients oftentimes want their medications to fit around their life, especially based on their symptoms. We know that with a disease like atopic dermatitis, it can be waxing and waning with flares, periods of quiescence, maybe even periods of remission. So, the dream has always been a medication or a medication plan that can fit around where somebody is at.”

Customary clinical trials often focus on continuous treatment regimens. However, real-world data and innovative trial designs are providing insights into how dosing can be modified to better meet patient needs.

Identifying Patients Who Benefit Most

Patients who respond well to initial treatment and achieve good control of their symptoms are often the best candidates for dose flexibility. DR. CHOVATIYA noted, “The patients that tend to respond the best to therapies, ones that have control of their signs and symptoms, are definitely the ones that are most amenable to some degree of dose flexibility.”

For biologic therapies, some patients might potentially be able to reduce dosing frequency from every two weeks to every four or eight weeks if they maintain good control of their AD.

Oral Therapeutics and Seasonal Considerations

While less studied in clinical trials, oral medications can also be used flexibly, particularly for patients with seasonal AD. DR. CHOVATIYA explained,”For people who have more seasonal disease,maybe during certain parts of the year,or people who are doing pretty well,they might be able to,perhaps,in a slightly off-label format,use their medication to fit their disease.”

Some patients may choose to use systemic therapy only during specific times of the year when their symptoms are most severe.Others may reduce the frequency of medication intake while still maintaining skin clearance. DR. CHOVATIYA acknowledges that while hard data is lacking, manny patients are already adopting these strategies in their daily lives.

Biologic Therapies: A Strategic Approach

When it comes to biologics, DR. CHOVATIYA advises against frequent starting and stopping of treatment, as this can diminish the therapy’s effectiveness. He recommends biologics for individuals who require year-round therapy. Once a patient is stable and well-managed,dose reduction may be an option.

He stated, “in the case of the biologics, again, I try to avoid too much starting and stopping here, because that can be associated with really losing an effect and maybe not getting the same efficacy you had before. Try to get individuals on biologic therapy who need to be on year-round therapy… and then once they’re doing pretty well, we have data from an approved label fashion in the case of traolkinumab, lebrikizumab, and nemolizumab, where people can move down to every 4 weeks or every 8 weeks of dosing. For dupilumab, on-dosing is every 2 weeks. But we actually do have clinical trial data to suggest that people who could go down to every 4 to 8 weeks and still maintain their responses.”²