Systemic Immunomodulatory Treatments for Patients With Atopic Dermatitis: A Systematic Review and Network...

Area of Science:

• Dermatology
• Immunology
• Clinical Pharmacology

Background:

• Atopic dermatitis (eczema) is a chronic inflammatory skin condition.
• Systemic immunomodulatory treatments are used for moderate to severe cases.
• Most trials compare treatments to placebo, limiting direct comparisons between therapies.

Purpose of the Study:

• To systematically compare the effectiveness and safety of systemic immunomodulatory treatments for atopic dermatitis.
• To conduct a network meta-analysis of randomized clinical trials.

Main Methods:

• Searched multiple databases (e.g., Cochrane, MEDLINE, Embase) and trial registries up to October 2019.
• Included 39 English-language randomized clinical trials (8+ weeks) of systemic immunomodulatory medications for moderate to severe atopic dermatitis.
• Performed random-effects Bayesian network meta-analyses and assessed evidence certainty using GRADE criteria.

Main Results:

• Included 39 trials with 6360 patients evaluating 20 medications.
• Dupilumab (300 mg every 2 weeks) significantly improved Eczema Area and Severity Index scores versus placebo (high certainty).
• Dupilumab and cyclosporine demonstrated comparable effectiveness in clearing skin signs, potentially superior to methotrexate and azathioprine (low to high certainty).

Conclusions:

• Dupilumab and cyclosporine may be more effective than methotrexate and azathioprine for up to 16 weeks in adults with atopic dermatitis.
• Investigational medications show promise, but data are limited.
• More comparative studies beyond 16 weeks are required.