Cyclosporine, dupilumab more effective in short term for atopic dermatitis

Cyclosporine and dupilumab may show more effectiveness up to 16 weeks in treating atopic dermatitis than methotrexate and azathioprine, according to a systematic review and network meta-analysis.

Thirty-nine randomized clinical trials, which included 6,360 patients, were reviewed and analyzed. They assessed 20 systemic immunomodulatory therapies, and most were compared with placebo.

Adult patients who received dupilumab 300 mg every 2 weeks had a reduction of 11.3 points in Eczema Area and Severity Index score compared with placebo.

Cyclosporine (standardized mean difference, 1.1; 95% credible interval, 1.7 to 0.5) and dupilumab (standardized mean difference, 0.9; 95% CrI,1.0 to 0.8) showed similarly effective results in clearing AD clinical signs compared with placebo. Methotrexate (standardized mean difference, 0.6; 95% CrI,1.1 to 0.0) and azathioprine (standardized mean difference, 0.4; 95% CrI, 0.8 to 0.1) were less effective.

“In the absence of well-powered head-to-head trials comparing all possible combinations of active treatments, our study provides the best available comparative effectiveness estimates to inform treatment decisions, guidelines and health technology assessments,” the study authors wrote.

Dupilumab, upadacitinib and abrocitinib all showed clinically meaningful improvement vs. placebo in Patient-Oriented Eczema Measure scores, and both dupilumab and abrocitinib were associated with significant improvements vs. placebo in Dermatology Life Quality Index scores.

“Dupilumab and higher-dose cyclosporine appear to have better effectiveness during the first 4 months of therapy in improving clinical signs, itch and quality of life relative to methotrexate and azathioprine,” the authors wrote. – by Rebecca L. Forand

Disclosures: Drucker reports he serves as an investigator for and receives research funding from Sanofi and Regeneron; serves as a consultant for Sanofi, RTI Health Solutions, Eczema Society of Canada and Canadian Agency for Drugs and Technology in Health; and receives honoraria from Prime Inc., Spire Learning, CME Outfitters, Eczema Society of Canada and Canadian Dermatology Association. His institution has received educational grants from Sanofi and AbbVie. Please see the study for all other authors’ relevant financial disclosures.