The following is a summary of “Systemic treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials,” published in the DECEMBER 2023 issue of Allergy & Immunology by Chu, et al.

Atopic dermatitis (AD) is a prevalent inflammatory skin ailment characterized by various systemic treatments. However, there remains a level of uncertainty regarding these treatments’ comparative efficacy and impacts on AD outcomes. For a study, researchers sought to systematically synthesize the advantages and potential harms associated with systemic treatments for AD.

In the context of the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, an exhaustive search was conducted across databases such as MEDLINE, EMBASE, CENTRAL, Web of Science, and GREAT. The search spanned from inception to November 29, 2022, targeting randomized trials centered on systemic treatments and phototherapy for AD. A meticulous process involving paired reviewers independently screened records, extracted pertinent data, and evaluated the potential risk of bias. Various AD-related parameters, including severity, itch, sleep, quality of life, flares, and adverse events, were examined using random-effects network meta-analyses. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was employed to ascertain the certainty of evidence. For transparency, this review is registered on the Open Science Framework.

The exhaustive analysis encompassed 149 trials, incorporating 28,686 patients diagnosed with moderate-to-severe AD and assessing 75 distinct interventions. High-certainty evidence underscored that high-dose upadacitinib emerged as particularly efficacious for five out of six patient-centric outcomes, albeit with heightened adverse event implications. Similarly, both high-dose abrocitinib and low-dose upadacitinib showcased significant efficacy for two outcomes, accompanied by notable adverse events. In contrast, dupilumab, lebrikizumab, and tralokinumab were deemed moderate efficacy while maintaining a more favorable safety profile. The analysis also highlighted that certain treatments, including azathioprine, oral corticosteroids, cyclosporine, methotrexate, mycophenolate, phototherapy, and various novel agents, necessitate further investigation to delineate their efficacy and safety profiles conclusively.

In the cohort of patients presenting with moderate-to-severe AD, robust evidence underscores the potent efficacy of high-dose upadacitinib across multiple critical outcomes. However, this efficacy is counterbalanced by increased adverse events. Both high-dose abrocitinib and low-dose upadacitinib exhibit notable efficacy but also pose increased risks. Meanwhile, dupilumab, lebrikizumab, and tralokinumab present moderately effective options with a more favorable safety profile.

Source: jacionline.org/article/S0091-6749(23)01112-0/fulltext