J Allergy Clin Immunol

AAAAI Conference: The most effective atopic dermatitis treatments may also be most harmful

March 6, 2024

Researchers performed a systematic review and meta-analysis to determine the comparative effectiveness of all available systemic treatments for atopic dermatitis (AD). The results, which were presented at the recent American Academy of Allergy, Asthma, & Immunology Annual Meeting (AAAAI), suggest that high-dose upadacitinib, high-dose abrocitinib, and low-dose upadacitinib were the most effective treatments for AD, but were also among the most harmful to patients. These findings inform patients, caregivers, and clinicians in achieving optimal AD care.

• 154 trials enrolling 29,831 patients (pediatrics and adults) and 78 unique interventions over a median of 13 weeks were selected by researchers.
• Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the certainty of evidence for AD severity, itch severity, sleep disturbance, AD-related quality of life, AD exacerbations, and adverse events.
• High-dose upadacitinib was among the most effective in improving multiple patient-important outcomes, but among the most harmful in terms of adverse events. High-dose abrocitinib and low-dose upadacitinib were intermediately effective, but also among the most harmful.
• Dupilumab, lebrikizumab, and tralokinumab were generally of intermediate effectiveness and among the safest, but modestly increased the frequency of conjunctivitis.
• Low-dose baricitinib was among the least effective across all outcomes.
• The benefits and harms of azathioprine, oral corticosteroids, cyclosporine, methotrexate, mycophenolate, phototherapy, and many novel agents were less certain.

Source:

Chu, A, et al. (2024, February). J Allergy Clin Immunol. Systemic treatments for atopic dermatitis: systematic review and network meta-analysis of randomized trials. https://www.jacionline.org/article/S0091-6749(23)01727-X/fulltext.