Systemic treatments for atopic dermatitis (eczema): systematic review and network meta-analysis of randomized trials
Chu, Alexandro W L ; Wong, Melanie M ; Rayner, Daniel G ; Guyatt, Gordon H ; Martinez, Juan Pablo Díaz ; Ceccacci, Renata ; Zhao, Irene X ; McMullen, Eric ; Srivastava, Archita ; Wang, Jason ... show 10 more
Citations
Authors
Wong, Melanie M
Rayner, Daniel G
Guyatt, Gordon H
Martinez, Juan Pablo Díaz
Ceccacci, Renata
Zhao, Irene X
McMullen, Eric
Srivastava, Archita
Wang, Jason
Wen, Aaron
Wang, Fang Chi
Brignardello-Petersen, Romina
Izcovich, Ariel
Oykhman, Paul
Wheeler, Kathryn E
Wang, Julie
Spergel, Jonathan M
Singh, Jasvinder A
Silverberg, Jonathan I
Ong, Peck Y
O'Brien, Monica
Martin, Stephen A
Lio, Peter A
Lind, Mary Laura
LeBovidge, Jennifer
Kim, Elaine
Huynh, Joey
Greenhawt, Matthew
Gardner, Donna D
Frazier, Winfred T
Ellison, Kathy
Chen, Lina
Capozza, Korey
De Benedetto, Anna
Boguniewicz, Mark
Smith Begolka, Wendy
Asiniwasis, Rachel N
Schneider, Lynda C
Chu, Derek K
Student Authors
Faculty Advisor
Academic Program
UMass Chan Affiliations
Document Type
Publication Date
Keywords
JAK inhibitors
Janus Kinase
abrocitinib
adverse events
atopic dermatitis
azathioprine
baricitinib
biologics
comparative effects
corticosteroids
cyclosporine
disease severity
dupilumab
eczema
immunomodulators
immunosuppressants
itch
lebrikizumab
light therapy
methotrexate
monoclonal antibodies
mycophenolate
narrow-band UVB
nemolizumab
network meta-analysis
patient-important outcomes
phototherapy
quality of life
sleep
systemic treatments
tralokinumab
upadacitinib
Subject Area
Embargo Expiration Date
Link to Full Text
Abstract
Background: Atopic dermatitis (AD) is an inflammatory skin condition with multiple systemic treatments and uncertainty regarding their comparative impact on AD outcomes.
Objective: We systematic synthesized the benefits and harms of AD systemic treatments.
Methods: For the 2023 AAAAI/ACAAI JTFPP AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, Web of Science, and GREAT, from inception to November 29, 2022, for randomized trials addressing systemic treatments and phototherapy for AD. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-quality of life, flares, and harms. The GRADE approach informed certainty of evidence ratings. OSF: https://osf.io/e5sna.
Results: 149 included trials (28,686 patients with moderate-to-severe AD) evaluated 75 interventions. With high-certainty, high-dose upadacitinib was among the most effective for five of six patient-important outcomes; high-dose abrocitinib and low-dose upadacitinib were among the most effective for two outcomes. These JAK inhibitors were among the most harmful in increasing adverse events. With high-certainty, dupilumab, lebrikizumab, and tralokinumab were of intermediate effectiveness and among the safest-modestly increasing conjunctivitis. Low-dose baricitinib was among the least effective. The efficacy and safety of azathioprine, oral corticosteroids, cyclosporine, methotrexate, mycophenolate, phototherapy, and many novel agents are less certain.
Conclusions: Among individuals with moderate-to-severe AD, high-certainty evidence demonstrates that high-dose upadacitinib is among the most effective in addressing multiple patient-important outcomes but also among the most harmful. High-dose abrocitinib and low-dose upadacitinib are effective, but also among the most harmful. Dupilumab, lebrikizumab, and tralokinumab are of intermediate effectiveness and favorable safety.
Source
Chu AWL, Wong MM, Rayner DG, Guyatt GH, Martinez JPD, Ceccacci R, Zhao IX, McMullen E, Srivastava A, Wang J, Wen A, Wang FC, Brignardello-Petersen R, Izcovich A, Oykhman P, Wheeler KE, Wang J, Spergel JM, Singh JA, Silverberg JI, Ong PY, O'Brien M, Martin SA, Lio PA, Lind ML, LeBovidge J, Kim E, Huynh J, Greenhawt M, Gardner DD, Frazier WT, Ellison K, Chen L, Capozza K, De Benedetto A, Boguniewicz M, Smith Begolka W, Asiniwasis RN, Schneider LC, Chu DK. Systemic treatments for atopic dermatitis (eczema): systematic review and network meta-analysis of randomized trials. J Allergy Clin Immunol. 2023 Sep 5:S0091-6749(23)01112-0. doi: 10.1016/j.jaci.2023.08.029. Epub ahead of print. PMID: 37678577.