Which immunomodulatory agent is most appropriate for a 17-year-old with severe atopic dermatitis and failure to methotrexate?

Dupilumab is the most appropriate choice for a 17-year-old patient with severe atopic dermatitis who has not responded to methotrexate. It is a monoclonal antibody that inhibits interleukin-4 and interleukin-13 signaling, which are key drivers in the inflammation and pathophysiology of atopic dermatitis. This targeted mechanism of action helps to effectively reduce the symptoms of atopic dermatitis, leading to better management of the condition.

In terms of safety and tolerability for adolescents, dupilumab has been studied and shown to be effective for those aged 12 years and older, making it an ideal option for a 17-year-old patient. Additionally, dupilumab is specifically indicated for moderate to severe cases of atopic dermatitis, especially for patients who have not adequately responded to other systemic therapies, such as methotrexate in this scenario.

Other choices, while they may have roles in managing atopic dermatitis, do not align as well with the current treatment guidelines or the specific needs of a patient experiencing severe symptoms. For instance, cyclosporine is an alternative immunosuppressant and can be used for severe atopic dermatitis, but it may carry risks of significant adverse effects and requires closer monitoring.