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Published on: July 11, 2013
Comparative efficacy of targeted systemic therapies for moderate-to-severe atopic dermatitis: a network meta-analysis
Mei Xiong1, QiaoLi Gao2, Xiaoxia Duan3
1Department of Dermatology, The First People's Hospital of Shuangliu District, West China (Airport) Hospital of Sichuan University, Chengdu, China.
Background:
The emergence of systemic targeted therapies for atopic dermatitis (AD) has significantly transformed the treatment landscape.
Objective:
This network meta-analysis aims to systematically evaluate the relative efficacy of approved systemic targeted therapies in adult patients with moderate-to-severe AD.
Methods:
Phase 3 or 4 randomized controlled trials (RCTs) assessing approved systemic targeted therapies for moderate-to-severe AD published up to July 29, 2025, were systematically identified. A Bayesian network meta-analysis was performed to analyze the proportion of patients achieving key efficacy indicators, including EASI-75, EASI-90, IGA 0/1, and NRS response.
Results:
A total of 27 reports encompassing 33 trials and 16,334 participants were included. The network meta-analysis demonstrated that Upadacitinib 30 mg consistently exhibited the highest probability of achieving each clinical endpoint. While pairwise comparisons revealed statistically significant differences among multiple targeted therapies, no significant differences were observed between dupilumab 300 mg and stapokibart 300 mg, or between ivarmacitinib 8 mg and upadacitinib 15 mg.
Conclusion:
Among currently approved targeted systemic therapies, upadacitinib 30 mg once daily ranked highest across all evaluated efficacy outcomes. However, these findings are derived primarily from indirect comparisons, and head-to-head randomized trials are needed to confirm the relative effectiveness of these therapies.
Insights
Upadacitinib 30mg showed the best results for moderate-to-severe atopic dermatitis (AD) among targeted systemic therapies. More head-to-head trials are needed to confirm these findings for systemic targeted therapies in AD.
Area of Science:
- Dermatology
- Pharmacology
- Clinical Research
Background:
- Systemic targeted therapies have revolutionized atopic dermatitis (AD) treatment.
- Moderate-to-severe AD requires effective systemic treatment options.
Purpose of the Study:
- To systematically evaluate and compare the relative efficacy of approved systemic targeted therapies for adult patients with moderate-to-severe AD.
- To identify the most effective treatment based on key clinical endpoints.
Main Methods:
- A Bayesian network meta-analysis of Phase 3 or 4 randomized controlled trials (RCTs) published up to July 29, 2025.
- Analysis of efficacy indicators including EASI-75, EASI-90, IGA 0/1, and NRS response.
Main Results:
- 27 reports (33 trials, 16,334 participants) were included.
- Upadacitinib 30mg demonstrated the highest probability of achieving all clinical endpoints.
- No significant differences were found between dupilumab 300mg and stapokibart 300mg, nor between ivarmacitinib 8mg and upadacitinib 15mg.
Conclusions:
- Upadacitinib 30mg once daily ranked highest among approved systemic targeted therapies for AD efficacy.
- Findings are based on indirect comparisons; head-to-head trials are necessary for definitive conclusions on relative effectiveness.
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