Abrocitinib and upadacitinib likely to be most effective immunomodulators for atopic dermatitis, but very expensive

Reference

Drucker AM, Morra DE, Prieto-Merino D, et al. Systemic immunomodulatory treatments for atopic dermatitis: Update of a living systematic review and network meta-analysis. JAMA Dermatol 2022;158(5):523-532.

Synopsis

A variety of new immunomodulatory drugs have recently been evaluated in patients with moderate to severe atopic dermatitis (AD), but there have been few head-to-head trials. This network meta-analysis identified 60 randomized trials with 16,579 children or adults, although there were too few trials to perform a network meta-analysis for studies in children. Most studies were judged to be at low risk of bias. The primary outcomes were changes in AD-specific symptom scores like the Eczema Area and Severity Index (EASI) and the Patient-Oriented Eczema Measure (POEM). Most studies were relatively short term (8 to 16 weeks), and results are not available for the few longer studies. They performed a surface under the cumulative ranking analysis, which estimates the likelihood that one drug is better than another based on a combination of direct and, in this case, mostly indirect comparisons. The primary drug for comparison was dupilumab (Dupixent). Based on the EASI and POEM symptom scores, there was good evidence that abrocitinib 200 mg once daily and upadacitinib 30 mg once daily were more effective than dupilumab. Lower doses were not more effective. Abrocitinib 100 mg, baricitinib 2 mg or 4 mg, and tralokinumab 600 mg then 300 mg were all likely to be less effective than dupilumab based on both EASI and POEM symptom scores.