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Which Systemic Therapies for AD Are More Effective?

A recent meta-analysis and systemic review found that dupilumab (Dupixent) and cyclosporine may have better short-term effectiveness compared with methotrexate and azathioprine for treating adult patients with atopic dermatitis.

In the study, the researchers analyzed data from randomized clinical trials of systemic immunodolatory medications for moderate to severe AD with 8 weeks or more of treatment. They identified 39 trials that included 6360 participants and assessed 20 medications and placebo. Data from these trials were extracted in duplicate and the researchers’ review adhered to the Preferred Reporting Items for Systemic Reviews and Meta-analyses for Network Meta-Analyses guidelines. Using the Grading of Recommendations Assessment, Development and Evaluation criteria, they assessed the certainty of evidence, and performed random-effects bayesian network meta-analyses. Outcomes included the change in signs of disease, symptoms, quality of life, itch, withdrawals, and serious adverse events.

Most trials were conducted for adults who were treated for up to 16 weeks, the researchers noted.
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Compared with placebo, dupilumab, administered at 300 mg every 2 weeks, was associated with improvements in Eczema Area and Severity Index score, the researchers said. They found that cyclosporine and dupilumab were similarly effective compared with placebo at clearing clinical signs of atopic dermatitis and noted that these medications may be superior to methotrexate and azathioprine.

In addition, several investigational medications for atopic dermatitis were found to be promising, but the data was limited to small early-phase trials, the researchers said. Safety analyses were limited by low event rates, they added.

“More studies directly comparing established and novel treatments beyond 16 weeks are needed and will be incorporated into future updates of this review,” the researchers concluded. They intend to update their analysis as new medications are approved.


Drucker AM, Ellis AG, Bohdanowicz M, et al. Systemic immunomodulatory treatments for patients with atopic dermatitis: A systematic review and network meta-analysis[ Published online April 22, 2020]. JAMA Dermatol.  doi:10.1001/jamadermatol.2020.0796


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