Atopic dermatitis treatments with greatest efficacy may also cause most harm

Key takeaways:

• Results showed high-dose upadacitinib was the most effective treatment, yet it increased any adverse event.
• Baricitinib was the least effective.

WASHINGTON — The most effective treatments for atopic dermatitis may also be the most harmful, according to a study presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“Atopic dermatitis is the most common inflammatory skin condition with an increasing number of available systemic interventions,” Alexandro Chu, BHSc, a student at McMaster University and the primary study author, said in an American Academy of Allergy, Asthma & Immunology press release. “We systematically reviewed and meta-analyzed the comparative benefits and harms of the available options and appraised the evidence using robust and standardized approaches.”

Chu and colleagues used both systemic and phototherapy treatments for AD to evaluate the effect that these treatments had on disease severity, itch, sleep disturbance, quality of life, exacerbations and adverse events. A multidisciplinary panel that included patients convened before the start of the study to establish the benefits and harms that were most important to patients.

Results were based on data from 154 trials that included 29,831 patients and 78 unique interventions over a median of 13 weeks.

High-dose upadacitinib proved to be among the most effective treatments; however, it was also one of the most harmful treatments and increased almost any adverse event. High-dose abrocitinib and low-dose upadacitinib, which both provided intermediate effectiveness, were also ranked among the most harmful treatments.

On the other hand, dupilumab, lebrikizumab and tralokinumab demonstrated intermediate effectiveness while also scoring as some of the safest treatments for AD. However, researchers reported a modest increase of conjunctivitis frequency with these treatments.

The researchers found that the least effective treatment for AD across all outcomes was low-dose baricitinib.

Data were uncertain concerning the benefits and harms of other therapies such as azathioprine, oral corticosteroids, cyclosporine, methotrexate, mycophenolate, phototherapy and many novel agents.

“Our findings have important and immediate implications for achieving optimal outcomes in patients with eczema requiring advanced therapy,” Chu said in the release.

Reference:

• Most effective atopic dermatitis treatments may also be most harmful. https://www.aaaai.org/about/news/news/2024/atopic. Published Feb. 5, 2024. Accessed March 4, 2024.