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Systemic Immunomodulatory Treatments for Atopic Dermatitis: Living Systematic Review and Network Meta-Analysis

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Lebrikizumab shows similar short-term efficacy to dupilumab for treating atopic dermatitis in adults. This comparison of systemic treatments aids clinicians and patients in making informed therapeutic choices.

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Area of Science:

  • Dermatology
  • Pharmacology
  • Clinical Trials

Background:

  • Atopic dermatitis has multiple approved systemic treatments.
  • Lebrikizumab is a new biologic medication.
  • Previous trials compared lebrikizumab to placebo, not other systemic treatments.

Purpose of the Study:

  • To conduct a living systematic review and network meta-analysis.
  • To compare the efficacy and safety of lebrikizumab against other systemic treatments for atopic dermatitis.

Main Methods:

  • Searched multiple databases (e.g., MEDLINE, Embase) and trial registries up to November 2023.
  • Included 97 randomized clinical trials with 24,679 patients, focusing on systemic immunomodulatory medications for moderate to severe atopic dermatitis.
  • Performed random-effects Bayesian network meta-analyses, assessing efficacy (EASI, POEM, DLQI, PP-NRS) and safety (adverse events).

Main Results:

  • Lebrikizumab demonstrated no important difference in efficacy compared to dupilumab for atopic dermatitis in adults over 16 weeks.
  • Dupilumab showed higher odds of efficacy in binary outcomes versus lebrikizumab.
  • High-dose upadacitinib and abrocitinib showed numerically highest relative efficacy; safety comparisons were limited by low event rates.

Conclusions:

  • Lebrikizumab is similarly effective to dupilumab for short-term treatment of adult atopic dermatitis.
  • These comparative data can inform clinical and patient treatment decisions.
  • Further research may be needed to fully assess long-term safety and efficacy differences.