Meta-analysis finds dosage affects efficacy of systemic atopic dermatitis treatments

Among systemic atopic dermatitis treatments, abrocitinib 200 mg and upadacitinib 30 mg had slightly better efficacy than dupilumab, according to a systemic review and network meta-analysis.

“Systemic immunomodulatory agents used to treat atopic dermatitis include cyclosporine, methotrexate, azathioprine, mycophenolate and dupilumab, with abrocitinib, baracitinib, tralokinumab and upadacitinib recently approved in various jurisdictions,” Aaron M. Drucker, MD, of the division of dermatology in the department of medicine at the University of Toronto, and colleagues wrote. “The sparsity of head-to-head trials for these medications makes direct comparisons of efficacy and safety difficult.”

A search of six clinical trial databases found 60 randomized clinical trials comprised of 16,579 patients with at least 8 weeks of treatment with one or more of the study drugs.

The highest reduction in Eczema Area and Severity Index scores was found in abrocitinib 200 mg daily and upadacitinib 30 mg daily, followed closely by dupilumab 600 mg then 300 mg every 2 weeks.

There was slightly less reduction in EASI scores with abrocitinib 100 mg daily, baracitinib 4 mg daily, baracitinib 2 mg daily and tralokinumab 600 mg then 300 mg every 2 weeks.

Upadacitinib 15 mg daily and dupilumab had similar EASI reductions.

“There was a consistent pattern across our main outcomes (EASI, POEM, DLQI, PP-NRS), with abrocitinib 200 mg daily and upadacitinib 30 mg daily associated with slightly better index scores, upadacitinib 15 mg daily associated with similar index scores, and abrocitinib 10 mg daily, baracitinib 2 mg and 4 mg daily, and tralokinumab 600 mg then 300 mg every 2 weeks associated with slightly worse index scores compared with dupilumab,” the authors wrote.

Abrocitinib 100 mg daily was 2.6 times more likely to have serious adverse events compared with dupilumab, which also had lower rates of adverse events compared with placebo.

“Our results may aid shared decision-making between clinicians and patients seeking to understand the relative merits of different treatment options for moderate to severe atopic dermatitis,” the authors wrote.