Ruxolitinib cream improves outcomes in atopic dermatitis: An updated systematic review and meta-analysis

Atopic dermatitis (AD) is a chronic skin disease marked by pruritus and barrier disruption. Though topical corticosteroids are standard, prolonged use may cause adverse effects. This updated meta-analysis assesses the efficacy and safety of ruxolitinib cream, a topical JAK1/JAK2 inhibitor, versus vehicle in AD treatment. PubMed, Embase, and Cochrane were searched up to April 2025 for RCTs evaluating ruxolitinib versus vehicle, following Cochrane and PRISMA guidelines. Primary outcomes included Investigator's Global Assessment-Treatment Success (IGA-TS) and 75% improvement in the Eczema Area and Severity Index (EASI75) at weeks 4 and 8; secondary outcomes included ≥4-point improvement in pruritus Numeric Rating Scale (NRS) at week 8 and incidence of at least one treatment-emergent adverse event (TEAE). Five RCTs (n = 1912) were included. Ruxolitinib significantly improved IGA-TS at 4 weeks (RR 4.56; 95% CI 3.01-6.92; p < .001) and 8 weeks (RR 4.00; 95% CI 2.97-5.38; p < .001), and EASI75 at 4 weeks (RR 3.10; 95% CI 1.79-5.38; p < .001) and 8 weeks (RR 3.16; 95% CI 2.21-4.51; p < .001). Benefits were consistent across age groups and dosages. Trial sequential analysis confirmed results' robustness. Pruritus NRS improved (RR 2.39; 95% CI 1.62-3.53; p < .001). TEAE risk was similar (RR 0.87; 95% CI 0.74-1.03; p = .10), though adolescents/adults had fewer events (RR 0.83; 95% CI 0.69-1.00; p = .04); children showed no significant increase (RR 1.14; 95% CI 0.74-1.75; p = .55). Ruxolitinib cream significantly improves IGA-TS, EASI75, and pruritus, with a comparable safety profile to vehicle.