Biologic Sequencing in Moderate to Severe Atopic Dermatitis: A Critical Appraisal of Current Guidelines and Practical Recommendations

Research Article | DOI: https://doi.org/10.31579/2578-8949/214

Biologic Sequencing in Moderate to Severe Atopic Dermatitis: A Critical Appraisal of Current Guidelines and Practical Recommendations

  • Ahmed M. Zahr Allayali *

Associate Professor of Dermatology, Internal medicine Department, Medical College, Umm Al-Qura University, Makkah, Saudi Arabia.

*Corresponding Author: Ahmed M. Zahr Allayali, Associate Professor of Dermatology, Internal medicine Department, Medical College, Umm Al-Qura University, Makkah, Saudi Arabia. ORCID: https://orcid.org/0000-0001-6863-2774

Citation: Ahmed M. Zahr Allayali, (2026), Biologic Sequencing in Moderate to Severe Atopic Dermatitis: A Critical Appraisal of Current Guidelines and Practical Recommendations, Dermatology and Dermatitis, 13(1); DOI:10.31579/2578-8949/214

Copyright: © 2026, Ahmed M. Zahr Allayali. This is an open-access article distributed under the terms of The Creative Commons. Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 28 May 2026 | Accepted: 12 June 2026 | Published: 18 June 2026

Keywords: atopic dermatitis; dupilumab; biologic therapy; therapeutic sequencing; clinical practice guidelines

Abstract

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense pruritus, skin barrier dysfunction, and type 2 immune dysregulation. Several biologics have been approved since the approval of dupilumab in 2017. However, current guidelines provide limited guidance on biologic sequencing, treatment non-response, and switching strategies.

Methodology: A focused narrative review of guidelines published between January 2017, and January 2026 was conducted using PubMed/MEDLINE, EMBASE, guideline-specific databases, and official dermatology society websites. Evidence from phase III clinical trials, real-world registries, and network meta-analyses was also incorporated and they were categorized into four evidence levels.

Results: Current guidelines recommend dupilumab as the first-line biologic therapy for moderate to severe AD. IL-13-selective biologics such as tralokinumab and lebrikizumab represent an effective alternative, particularly for patients with ocular surface disease, while nemolizumab may be beneficial in pruritus-dominant disease. However, no currently appraised guideline provides a validated second-line biologic sequencing following dupilumab non-response.

Conclusion: Current guidelines fall short in addressing biologic sequencing for treatment-experienced AD patients. A mechanism-informed, phenotype-guided framework has been provided as a Level IV conceptual model to support clinical decision making until evidence from head-to-head trials, standardized definitions, and biomarker-driven treatment strategies become available.

List of Abbreviations

AAD: American Academy of Dermatology AD: Atopic dermatitis; BAD: British Association of Dermatologists; BNMA: Bayesian network meta-analysis; CRSwNP: Chronic rhinosinusitis with nasal polyps; DLQI: Dermatology Life Quality Index; EADV: European Academy of Dermatology and Venereology; EASI: Eczema Area and Severity Index; EoE: Eosinophilic esophagitis; IGA: Investigator Global Assessment; IL: Interleukin; JAK: Janus kinase; MACE: Major adverse cardiovascular events; NMA: Network meta-analysis; OSD: Ocular surface disease; PEDISTAD: PEDIatric STudy in Atopic Dermatitis; POEM: Patient-Oriented Eczema Measure; PP-NRS: Peak Pruritus Numeric Rating Scale; RCT: Randomized controlled trial; SUCRA: Surface Under the Cumulative Ranking Curve; VTE: Venous thromboembolism.

Introduction

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by intense pruritus, epidermal barrier dysfunction, and type 2 immune dysregulation. It is most common in around 10-15% of children and 4–8% of adults worldwide, which represents a major public health issue that significantly affects the quality of life and psychological well-being [1–3]. AD is often associated with other medical conditions such as asthma, allergic rhinitis, food allergy, anxiety, and depression, reflecting its systemic and multifactorial nature [4,5].

To manage moderate to severe AD, the use of topical corticosteroids, calcineurin inhibitors, and broad immunosuppressants such as cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil has been known for decades. These therapies have offered some relief from symptoms in many patients; however, their long-term use was hampered by variable efficacy, toxicity concerns, and inadequate disease control [6,7]. A major breakthrough in therapeutics was marked by the approval of Dupilumab in 2017, demonstrating significant clinical efficacy superior to conventional immunosuppressants, thereby transforming the treatment scenario and reshaping subsequent guideline development [3,8].

Subsequent approvals of additional targeted biologics, including IL-13 inhibitors tralokinumab and lebrikizumab, as well as anti-IL-31Rα monoclonal antibody nemolizumab, have expanded the therapeutic armamentarium for AD [7,9]. Furthermore, emerging agents targeting OX40, OX40 ligand (OX40L), and IL-33 are in advanced stages of clinical development [9,10]. This proliferation requires clinicians to navigate not only agent selection but biologic sequencing, a domain where practice consistently outpaced guideline development.

Current international guidelines provide robust first-line recommendations but offer limited structured guidance on questions encountered daily in practice, such as What constitutes primary versus secondary non-response? When and to which agent should a clinician switch? How should comorbidities such as conjunctivitis, eosinophilic esophagitis, or cardiovascular disease influence sequencing? What evidence supports second- and third-line biologic use?

This review appraises guideline recommendations from the AAD (2023), EADV (2022), BAD (2023), and Asia-Pacific AD guidelines with a specific focus on biologic sequencing, identifies gaps between recommendations and real-world clinical needs, and proposes a mechanism-informed framework for managing biologic-experienced patients.

Methods

A targeted literature search was conducted using PubMed/MEDLINE, EMBASE, guideline-specific databases (GIN, NICE, AAD Guidelines Central), and official society websites. The primary search window was between January 2017 and December 2024, including the dupilumab approval era.

Priority was given to guidelines from major international dermatological societies, including the American Academy of Dermatology (AAD), European Academy of Dermatology and Venereology (EADV), and British Association of Dermatologists (BAD), together with pivotal peer-reviewed clinical studies relevant to biologic therapy in atopic dermatitis (AD). Sources were selected based on their scientific relevance rather than exhaustive retrieval, representing an inherent limitation in designing the review.

The evidence discussed in this review was categorized into four major levels: Level I, including phase II–III randomized controlled trials (RCT) and meta-analyses; Level II comprised Bayesian network meta-analyses; Level III included prospective registries and multicenter observational studies; and Level IV considered as expert consensus statements, position papers, and narrative reviews [11,12].

Major phase III clinical trials that inform about recent biologics use in AD are reviewed, including LIBERTY AD SOLO 1 and 2, ECZTRA 1 and 2 for tralokinumab, ADvocate 1 and 2 for lebrikizumab, and ARCADIA 1 and 2 for nemolizumab [13,14].  Real-world evidence from large observational studies and registries, including EUROSTAD, TARGET-DERM, BioDay, and PEDISTAD, was also incorporated to complement the trial dataset and improve clinical applicability [6,15,16]. Although a formal systematic review methodology was not employed, a structured, selective approach was used to include the most clinically relevant guidelines, major trials, and real-world examples relevant to biologic sequencing in AD.

The Approved Biologic Landscape in Atopic Dermatitis 

Dupilumab: The Anchor Agent

Dupilumab is a monoclonal antibody (mAb) that simultaneously inhibits IL-4 and IL-13 by blocking the IL-4 receptor alpha (IL-4Rα) subunit. In phase III trials of LIBERTY AD SOLO 1 and 2 have demonstrated EASI-75 responses in 44–51% of patients at week 16 compared with 12–15% for placebo-treated patients (Level I) [8]. Further, long-term extension studies showed sustained efficacy and safety up to three years [17]. It is currently approved for patients spanning from ≥6 months to adulthood, which makes it the broadest approved range biologic for AD [6,18]. Registered data demonstrate a high adult drug survival rate reaching 80–90% at 3 years, substantially higher than conventional systemic agents such as cyclosporine (20–37%) [3,19]. Ocular surface disease (OSD) remained the most recognized adverse effect, reported to affect 8–11% of patients in clinical trials, whereas real-world registries have mentioned the rates reaching up to 40% in selected populations [3].

Tralokinumab and Lebrikizumab: The IL-13 Selective Agents 

Tralokinumab and lebrikizumab selectively target IL-13 signaling without affecting IL-4 pathways. In ECZTRA 1 and 2 phase III trials, it has achieved Investigator’s Global Assessment (IGA) 0/1 responses in 15.8–22.2% of patients at 16 weeks [13,20].

Lebrikizumab has demonstrated a higher response rate for ADvocate 1 and 2 clinical trials, with IGA 0/1 responses in 29.1–43.1%, with the lowest conjunctivitis rates of any approved agent [21]. Both of these agents (tralokinumab and lebrikizumab) are approved for adult and adolescent patients aged ≥12 years.

In comparison with dupilumab, IL-13 selective agents appear to have fewer adverse effects, including OSD. Bayesian NMA ranked dupilumab the highest among effective biologics (SUCRA 96%), whereas lebrikizumab was ranked fourth (SUCRA 75%) and tralokinumab tenth (SUCRA 48%), indicating lebrikizumab as the most dupilumab-comparable alternative pending head-to-head data [22,23].

Nemolizumab: Targeting the Itch-Barrier Axis

Nemolizumab targets IL-31Rα to modulate the neuroimmune pathways involved in pursuits and skin barrier dysfunction. In the ARCADIA 1 and 2 phase III trials, nemolizumab significantly reduced the pruritus numerical rating scale (PP-NRS) score, with itch relief observed within the first week of treatment, along with improvements in EASI and IGA outcomes [24] It received FDA approval in 2024, covering both AD and prurigo nodularis in patients aged ≥12 years.

Pediatric phase III data in children aged 6–12 years have shown significant antipruritic efficiency compared to placebo from day 2 of treatment [25,26]. Nemolizumab may be particularly useful in patients with pruritus-dominant AD phenotype; combinatorial use with IL-4/IL-13 biologics is mechanistically plausible, but valid evidence is still lacking [3,19]. Table 1 summarizes the currently approved biologic therapies for atopic dermatitis, including their molecular targets, mechanisms of action, efficacy outcomes, and major adverse events.

AgentTargetMechanismKey Trial (Adults)IGA 0/1 at 16 weeksNotable Adverse EffectsReferences
DupilumabIL-4RαBlocks IL-4 + IL-13LIBERTY AD SOLO 1&238–42%Conjunctivitis (8–11%)(8)
TralokinumabIL-13Selective IL-13 neutralizationECZTRA 1&216–21%Conjunctivitis (< dupilumab>(13)
LebrikizumabIL-13Selective IL-13 neutralizationADvocate 1&229–33%Conjunctivitis (lowest rate)(21)
NemolizumabIL-31RαBlocks the neuroimmune itch axisARCADIA 1&236–40%Nasopharyngitis, headache(27)

Table 1: Comparative overview of approved biologic agents for moderate-to-severe atopic dermatitis

Comparative Appraisal of International Guidelines 

First-Line Biologic Selection: Points of Consensus

Current guidelines, including AAD (2023), EADV (2022), BAD (2023), and Asia Pacific expert consensus groups, have converged on a fundamental recommendation: the first-line biologic agent for adult patients with moderate-to-severe AD who have an inadequate response to, or are intolerant to, conventional systemic immunosuppressants [1,6,28]. This consensus is largely based on dupilumab's robust and long-term efficacy, long-term safety dataset among approved AD biologics, and approval in the broadest age range, including children as young as 6 months [6,19].

The AAD 2023 guideline has provided dupilumab with a strong recommendation (Level I) based on high certainty evidence and positions tralokinumab and lebrikizumab as conditional effective alternatives, based on robust phase III clinical trials [6]. Likewise, the EADV 2022 guideline endorses dupilumab as preferred first-line biologics, while IL-13-selective agents are recognized as appropriate alternatives for patients with dupilumab-associated OSD or in situations where selective IL-13 may be clinically advantageous [1].

Currently available international guidelines differ in the level of detail provided for biologic sequencing, non-response treatment definitions, special population management, and the role of the newer biologic agents. A comparative summary of key recommendations from different international guidelines is presented in Table 2.

DomainAAD 2023EADV 2022BAD 2023Asia Pacific
First line biologicDupilumab (strong recommendation)Dupilumab (preferred)Dupilumab (recommended)Dupilumab (preferred)
Alternative first-line biologicsTralokinumab / lebrikizumab (conditional recommendation)Tralokinumab / lebrikizumab (alternative options)Tralokinumab (alternative)Limited guidance
Non-response definitionNot clearly definedPartial response is defined as < EASI>Limited guidance; reassessments at 16 weeksNot defined
Second-line therapy after dupilumab failureNot specifiedExpert consensus favors class switchingSwitch to alternative biologic suggestedNot specified
Comorbidity-guided biologic selectionDetailed recommendations availableDetailed recommendations availablePartial recommendations availableLimited recommendations available
Nemolizumab guidanceNot yet includedNot yet includedNot yet includedNot yet included
PregnancyMay consider dupilumabInsufficient evidenceNot addressedNot addressed

Table 2: Comparative overview of international guideline recommendations for biologics and sequencing in atopic dermatitis. Information provided in this table is a synthesis of guidelines recommendations and expert consensus provided in AAD 2023 (6), EADV 2022 (28), BAD 2023 (29) and Asia Pacific guidance (30).

Sequencing After Biologic Non-Response: The Critical Gap

Despite increasing therapeutic opportunities, none of the currently available guidelines provide a structured, evidence-based algorithm for biologic sequencing after dupilumab non-response. Use of alternative biologics has also been acknowledged in the AAD guidelines; however, they do not define standardized criteria for primary or secondary non-response [6]. The EADV guideline proposes personalized switching, but relies primarily on expert opinion due to the absence of comparative prospective evidence [1]. Similarly, the BAD guidelines recommend assessments after 16 weeks of therapy but do not incorporate mechanistic or phenotype-based approaches [1]. The sequencing guidelines in the Asia-Pacific recommendations remain similarly limited.

An expert-level hypothesis (Level IV) suggests that patients with primary dupilumab non-response may have a signaling pathway inadequately suppressed by dual IL-4/IL-13 blockade that could also respond less favorably to selective IL-13 inhibition. However, this should not categorically exclude IL-13-selective agents after dupilumab primary failure; real-world data suggest intra-class switching for tolerability-driven discontinuation, such as conjunctivitis, rather than lack of efficacy [15,19]. Currently available guidelines do not adequately distinguish this major gap in clinical guidance.

Special Populations and Comorbidity-Guided Sequencing 

Dupilumab offers an additional approved indication beyond AD, including Eosinophilic Esophagitis (EoE), asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), prurigo nodularis, and alopecia areata, among others. Consequently, both AAD and EADV guidelines favor this biologic for patients with these comorbid conditions [1,6]. For patients with severe dupilumab-associated conjunctivitis, despite topical management, tralokinumab or lebrikizumab are recommended alternatives because of their reported lower OSD rates [1]. In contrast, nemolizumab may be very beneficial, particularly for pruritus-dominant disease, characterized by inflammatory phenotypes with significant sleep disruption; given its IL-31signaling inhibition along the neuroimmune itch pathway. However, formal guideline incorporation is anticipated in forthcoming updates (6,27,28).

Pregnancy and lactation remain areas with limited guideline-directed recommendations. Recent studies have documented a low risk of major adverse maternal or neonatal outcomes with dupilumab exposure during pregnancy. Available pharmacokinetic data suggested minimal transfer into breast milk, approximately 1.3% of the maternal plasma dose [31]. Nevertheless, product labeling recommends temporary discontinuation when appropriate; however, the AAD 2023 guidelines supports the use of dupilumab in pregnancy when expected benefits clearly outweigh the potential risks [6].

Toward a Practical Biologic Sequencing Framework 

Defining Response and Non-Response

The lack of standardized definitions for biologic treatment response and non-response is one of the major problems with the current atopic dermatitis guidelines. Primary non-response is conceptually defined as at least 50% improvement in the Eczema Area Severity Index (EASI-50) after 16 weeks of therapy with documented adherence. Secondary non-response refers to those patients who initially achieved EASI-50, but later reduced to more than 30% over at least 8 weeks [6,28]. Primary non-response more likely reflects mechanistic inadequacy to suppress the dominant inflammatory pathway, whereas secondary non-response may result from anti-drug antibody formation, disease phenotype shift, or comorbid diseases [15,28,32]. Mechanistic class switching is most recommended in case of confirmed primary non-response, whereas optimization strategies are reasonable in case of secondary non-response. However, this concept is largely based on expert opinion and observational evidence (Level IV), and prospective validation is required.

Phenotype- and Comorbidity-Informed Selection

The large number of biologic therapies for AD highlighted the importance of individualized treatment selection based on disease, some key phenotypic dimensions that include: 

  1. Atopic comorbidity burden: the multi-indication approvals of dupilumab favor its use in patients with concurrent asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), or Eosinophilic Esophagitis (EoE) [33,34];
  2. Patients with preexisting OSD: IL-13-selective agents such as tralokinumab or lebrikizumab is preferred for comparatively lower adverse effects [13,15].
  3. Pruritus predominance: Nemolizumab is particularly useful for patients with severe PP-NRS (≥7) with sleep disruption [21,24].
  4. Pediatric profile:  Dupilumab holds the broadest pediatric approval (starting from ≥6 months) [14,34].

In addition to these practical considerations, such as reimbursement policies, regional regulatory approvals, treatment accessibility, and future biosimilar availability, etc., are some other major determinants of biologic sequencing and long-term therapeutic sustainability [32].

Proposed Biologic Sequencing Framework 

Based on the preceding appraisal of current evidence and guideline limitations, a mechanism-informed, phenotype-guided biologic sequencing framework is proposed as a conceptual clinical model. It reflects expert consensus and theoretical reasoning, not an evidence-validated clinical guideline, and therefore, it should not be applied prescriptively; it represents expert-informed consensus pending prospective validation.

Step 1- Optimized conventional therapy (3-6 months): Topical corticosteroids along with calcineurin inhibitors with or without PDE4 inhibitors (crisaborole or roflumilast); assess for uncontrolled comorbid triggers before escalating to systemic therapy [28,35]

Step 2- First biologic: Dupilumab is preferred in all patients without contraindication. Tralokinumab or lebrikizumab are alternatives for patients with high conjunctivitis risk, dupilumab intolerance, or specific type 2 comorbidity profiles where selective IL-13 inhibition is preferred [13,21,28,35].

Step 3A- Primary non-response at 16 weeks ( First, evaluate adherence, concurrent infectious triggers, and adequacy of concomitant topical therapy before conclusion of failure. For confirmed dupilumab primary non-response cases, switching to an IL-13-selective agent remained supported by theoretical rationale and limited evidence [28]. Transition to Janus kinase (JAK) inhibitors may be considered for younger patients with appropriate cardiovascular, thromboembolic, and malignancy risk stratification [3,36].

Step 3B- Secondary non-response: Reassessment should include evaluating for anti-drug antibodies, adherence, and uncontrolled comorbid disease. Optimizing topical therapy and managing triggering factors may exacerbate the disease in some cases. Consider intra-class switching, such as from dupilumab to tralokinumab or lebrikizumab, may also be considered in selected cases. Reserve JAK inhibitors for refractory disease with adequate risk-benefit documentation [37].

Step 4 - Pruritus-dominant residual disease: In patients with persistent severe pruritus (PP-NRS ≥7) despite adequate lesional control on an IL-4/IL-13 pathway biologic, addition of nemolizumab may be considered. As a standalone first-line biologic in a specific pruritus-dominant, lesion-minimal phenotype, nemolizumab remains exploratory (Level IV), is not yet endorsed by any current major international guidelines,s and requires prospective validation before it can be regarded as established practice [24,27,28,35].

Step 5 - Pipeline agents: Several emerging biologic agents like Anti-OX40 (rocatinlimab), anti-IL-33 (itepekimab) and anti-OX40L (amlitelimab) are in advanced clinical development and may expand further for future sequencing strategies when approved based on available evidences [38,39].

The Interface of Biologics and JAK Inhibitors in Sequencing

Several JAK inhibitors, like upadacitinib, baricitinib, abrocitinib, etc., offer blockade of intracellular JAK-STAT signaling with higher short-term skin clearance than approved T2 biologics to modulate multiple inflammatory pathways [6,28]. Upadacitinib 30 mg achieved EASI-90 responses in approximately 60–62% of patients at 16 weeks in phase III studies [36,40]. The FDA’s 2021 Boxed Warning (major adverse cardiovascular events (MACE), venous thromboembolism (VTE), malignancy, infections) necessitates individualized risk stratification and documented informed consent before use. Current guidelines support biologic-first positioning in patients aged over 50 or with cardiovascular risk factors, a history of malignancy, or prior herpes zoster [1,3]. In contrast, JAK inhibitors may be considered in younger biologic-refractory patients without relevant comorbidities, after careful individual documentation of risk-benefit discussion [6,21,26].

Real-World Evidence and Its Implications for Sequencing

Real-world evidence has become an increasingly essential source of information to complement RCT findings with respect to persistence, efficacy, safety, and switching of the treatment regimen. Results from the EUROSTAD registry, which comprised a sample of over 3,000 biologic-naive AD patients with moderate-to-severe AD, indicated that 60% of patients had an EASI-75 response after treatment with dupilumab for 24 weeks [41]. Evidence from other real-world scenarios has helped shape biological switching approaches. A recently conducted Danish study, published in 2023, showed that switching from dupilumab to tralokinumab due to dupilumab-induced conjunctivitis was accompanied by great clinical success, as about 89% of patients reached the OSD remission stage while keeping their AD under control [42].

Long-term real-world effectiveness data from the Dutch BioDay registry have also provided important insights into treatment durability and patient-reported outcomes. A study involving a population of 1,223 patients followed up to 5 years confirms durable Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), and Numerical Rating Scale (NRS)-pruritus score improvements, with 73.5% of adults achieving well-controlled disease by composite PROM criteria, and work productivity impairment declining from 40.1% to 13.3–16.3% [43]. Itch-dominant phenotype and class I obesity predicted lower composite patient-reported outcome measures (PROM) response rates, directly informing phenotype-guided sequencing. Conjunctivitis affected 33.7% of patients, among them 69.7% experiencing moderate-to-severe disease [43].

The PEDISTAD registry, showing a 2-year observational study involving 379 children younger than 12 years of age, confirmed the superior effectiveness of dupilumab over methotrexate and cyclosporine, where the mean EASI declined from 20.9 to 8.6 with a lower rate of discontinuation (8.3% vs. 28.9% and 43.0%) than those observed in conventional immunosuppressants [44]. Formal pediatric sequencing guidance remains absent despite these differences [44].

Emerging real-world data indicate that dose-interval extension beyond the FDA-approved regimen for dupilumab may be feasible for select responders with sustained disease control. De Bruin-Weller et al. (2026) have reported that almost 83% of patients were able to maintain clinical effectiveness upon tapering to Q3W or Q4W regimens, where type 2 inflammation biomarkers such as TARC/CCL17 and PARC/CCL18 remained suppressed throughout the duration of follow-up [3]. Moreover, there was potential for significant healthcare cost savings, where the reduction in costs was predicted to approach €4 million over a period of 3.5 years in 401 patients. Similarly, Tralokinumab and lebrikizumab permit Q4W step-down after week-16 response [3]. This is an important consideration for biologic sequencing, since a patient with sustained disease control can be extended on interval therapy without changing to another class of biologics.

Indirect comparative evidence from a well-established network meta-analysis (NMA) by Drucker et al. (Level II evidence) identified dupilumab as the most consistently effective approved systemic biologic agent across multiple efficacy outcomes in moderate to severe AD [22]. More recently, Bayesian NMA by Babul et al. (2026), incorporating 17 RCTs and 6,366 patients, reported findings that broadly corroborate with previous analysis, ranking dupilumab highest across four predefined efficacy endpoints [23].

Strengths and Limitations of the Study

The strengths of this review lie in the integration of evidence across multiple levels (RCTs, registries, network meta-analysis) and an additional four-tier evidence grading made by the authors, which helps to assess claims effectively. One of the major limitations of the study is its review design. No attempt was made to use a comprehensive source selection, which may lead to selection bias. The lack of a formal systematic review protocol might introduce selection bias, but this approach was chosen to enable a focused, clinically oriented synthesis of rapidly evolving evidence. Another limitation of this study is that all of the proposed sequencing frameworks provide only Level IV evidence and have never been prospectively validated. Future AD guidelines should seek to reach the level of specificity achieved in psoriasis guidelines.

Conclusion

The introduction of biologic therapies has significantly transformed the management of moderate to severe AD, with current guidelines aligned with dupilumab as the preferred first-line biologic. However, despite the expanding therapeutic landscape, it falls substantially short on structured sequencing guidance for biologic-experienced patients. Defined non-response criteria, switching algorithms, and integrated real-world evidence remain absent. The mechanism-informed framework proposed herein offers a scaffold for clinical decision-making; urgent priorities include head-to-head biologic switching trials, standardized response definitions, and biomarker-driven stratification.

Declaration of Competing Interests

Conflict of Interest: The author declares that they have no conflict of interest.

Compliance with Ethical Standards

Ethical approval: This article does not contain any studies with human participants or animals performed by any of the authors.

Acknowledgments

The author declares no funding sources for this review. The author thanks colleagues in the Department of Dermatology for critical review of earlier manuscript drafts.

Author Qualification Statement

Ahmed M. Zahr Allayali is a dermatologist with clinical and academic experience in inflammatory dermatoses and systemic therapy for atopic dermatitis.

Contribution Details

Ahmed M. Zahr Allayali: Concepts; design; definition of intellectual content; literature search; data analysis and interpretation; manuscript preparation, editing, and review. Ahmed M. Zahr Allayali accepts full responsibility for the integrity of the work and is designated as guarantor.

Declaration of Competing Interests

The author declares no competing interests.

Funding

No external funding was received for this work.

References

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Dr SABITA SINHA

Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.

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Dr Ted Christopher

International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.

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Joel Yat Seng Wong

Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.

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Dr Mamoun Magzoub

Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.

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Baciulescu Laura

Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal

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Christoph Maurer

Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.

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Dr Elena Salvatore

Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed

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Mahmoud Kamal Moustafa Ahmed

Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.

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Dr Meng-JouLe

Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell

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Dr Andriy Sinelnyk

I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.

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Edouard Kujawski

Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.

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Dr Matteo Bonori

Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti

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Dr Claudio Ligresti

Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.

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Dr Chiara Giuseppina Beccaluva

Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.

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Dr Aline Tollet

Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.

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Dr Ravi Shrivastava

Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora

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Dariusz Ziora

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.

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Dr Jelle Lettinga

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.

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Dr Walter F Riesen

Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.

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Dr Rakhi Mishra

Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.

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Hala Al Shaikh

Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD

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Dr Eric S Nussbaum

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.

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Dr Victor Olagundoye

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.

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Dr Farahnaz Fallahian

Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

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Prof Sherif W Mansour

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

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Bernard Terkimbi Utoo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

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Pedro Marques Gomes

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

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Anthony Kodzo-Grey Venyo

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

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Katarzyna Byczkowska

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

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Orlando Villarreal

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

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Sing-yung Wu

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

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Layla Shojaie

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

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Mina Sherif Soliman Georgy

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

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Ziemlé Clément Méda

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

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Delcio G Silva Junior

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

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Virginia E. Koenig