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This systematic review and network meta-analysis was conducted to assess the comparative effectiveness of targeted systemic treatments devoid of topical calcineurin inhibitors (TCI) and/or topical corticosteroids (TCS) for moderate to severe atopic dermatitis (AD) patients.
In patients suffering from atopic dermatitis, 30 mg upadacitinib every day seems to be the most effective targeted treatment, followed by 15 mg upadacitinib daily and 200 mg abrocitinib daily, across 12 or 16 weeks of therapy.
This systematic review and network meta-analysis was conducted to assess the comparative effectiveness of targeted systemic treatments devoid of topical calcineurin inhibitors (TCI) and/or topical corticosteroids (TCS) for moderate to severe atopic dermatitis (AD) patients.
Databases were searched to find out phase 3/4 trials. JAK inhibitors, interleukin-13 (IL-13), interleukin-4 (IL-4), or upadacitinib in comparison with placebo or active intervention for moderate to severe AD patients (adolescents/adults) for whom TCS/TCI was clinically inadvisable or who exhibited an ineffective response to TCI/TCS, with no restrictions on year or region was searched.
A total of six records representing nine studies with 2 upadacitinib trials were incorporated in the network meta-analysis. Eleven clinical trials incorporating 6254 individuals were examined.
The data was evaluated utilizing PRISMA guidelines. Utilizing a Bayesian network meta-analysis, the percentage of individuals attaining trial co-primary endpoints
[Investigator Global Assessment (IGA) score of 0 or 1 (clear /almost clear) and decrease of ≥ 2 points from the baseline; percentage of people attaining Eczema Area and Severity Index (EASI) enhancement ≥ 75% from the baseline (EASI-75)]; EASI enhancement ≥ 90% from the baseline (EASI-90); and ≥ 4-point enhancement on Pruritus Numerical Rating Scale from the baseline were assessed.
Notably, 30 mg upadacitinib every day was the most effective treatment across all outcomes at week 12 or 16 and at earlier time points, and after that 15mg upadacitinib every day and 200 mg abrocitinib every day.
To conclude, 30 mg of upadacitinib appears to be the most effective targeted systemic therapy for AD.
Dermatology and Therapy
Comparative Efficacy of Targeted Systemic Therapies for Moderate to Severe Atopic Dermatitis without Topical Corticosteroids: Systematic Review and Network Meta-analysis
Jonathan I. Silverberg et al.
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