Meta-analysis sorts out best systemic treatment for atopic dermatitis

  • Drucker AM & al.
  • JAMA Dermatol
  • 22/04/2020

  • Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • According to this meta-analysis, compared with respective placebos, cyclosporine or dupilumab bests methotrexate or azathioprine for patients with atopic dermatitis.

Why this matters

  • Few trials have assessed the relative efficacy of systemic immunomodulatory treatments for atopic dermatitis.

Key results

  • Higher-dose cyclosporine or a dupilumab regimen is similarly effective at clearing clinical signs of atopic dermatitis:
    • Cyclosporine vs placebo, standardized mean difference (SMD): −1.1 (95% credible interval [CI], −1.7 to −0.5; low certainty). 
    • Dupilumab vs placebo, SMD: −0.9 (95% CI, −1.0 to −0.8; high certainty).
  • Cyclosporine and dupilumab performed better vs their respective placebos than:
    • Methotrexate vs placebo, SMD: −0.6 (95% CI, −1.1 to 0.0; low certainty). 
    • Azathioprine vs placebo, SMD, −0.4 (95% CI, −0.8 to −0.1; low certainty).

Study design

  • Meta-analysis of data from 39 trials with 6360 patients examining 20 medications, each vs its respective placebo.
  • Funding: UK National Institute for Health Research; Eczema Society of Canada; Academic Health Science Centres of Ontario.

Limitations

  • Heterogeneity among included studies.
  • Short trial duration for most included studies.