Systemic treatments for eczema: a network meta-analysis.

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Eczema (atopic dermatitis) is a chronic inflammatory skin condition significantly impacting quality of life.
• Moderate to severe eczema poses challenges for effective long-term management.
• Current treatment benefits are unclear due to limited head-to-head comparative trials.

Purpose of the Study:

• To conduct a network meta-analysis (NMA) comparing systemic immunosuppressive treatments for moderate to severe eczema.
• To rank treatments based on efficacy (EASI75, POEM) and safety (SAEs, infection).

Main Methods:

• Systematic search of multiple databases up to August 2019.
• Inclusion of randomized controlled trials (RCTs) comparing systemic immunosuppressive agents against placebo or other treatments.
• Data synthesis using pairwise analysis and NMA, assessing outcomes at short-term (≤16 weeks) and long-term (>16 weeks) follow-up.

Main Results:

• Dupilumab demonstrated superior short-term efficacy compared to placebo for Eczema Area and Severity Index 75 (EASI75) and Patient-Oriented Eczema Measure (POEM) improvement (high-certainty evidence).
• Evidence for the efficacy and safety of most other immunosuppressive agents was of low or very low certainty.
• Dupilumab and ustekinumab were the only agents evaluated for longer-term EASI75; dupilumab was the only agent for short-term POEM.

Conclusions:

• Dupilumab is the most effective biological treatment for short-term management of moderate to severe eczema.
• High uncertainty remains regarding the comparative efficacy and safety of conventional versus newer biological treatments.
• Further head-to-head RCTs are needed to evaluate long-term comparative efficacy and safety.