systemic immunomodulatory treatments for atopic dermatitis update of a living systematic CORD-Papers-2022-06-02 (Version 1)

Title: Systemic Immunomodulatory Treatments for Atopic Dermatitis: Update of a Living Systematic Review and Network Meta-analysis.
Abstract: Importance Systemic treatments for atopic dermatitis are being evaluated primarily in placebo-controlled trials; network meta-analysis can provide relative efficacy and safety estimates for treatments that have not been compared head to head. Objective To compare reported measures of efficacy and assessments of safety in clinical trials of systemic treatments for atopic dermatitis in a living systematic review and network meta-analysis. Data Sources The Cochrane Central Register of Controlled Trials MEDLINE Embase Latin American and Caribbean Health Science Information database Global Resource of EczemA Trials database and trial registries were searched through June 15 2021. Study Selection Randomized clinical trials examining 8 or more weeks of treatment with systemic immunomodulatory medications for moderate-to-severe atopic dermatitis were included after screening titles abstracts and papers in duplicate. Data Extraction and Synthesis Data were abstracted in duplicate. Bayesian network meta-analyses and assessed Grading of Recommendations Assessment Development and Evaluation certainty of evidence were performed. The updated analysis was completed from June to December 2021. Main Outcomes and Measures Outcomes include change in Eczema Area and Severity Index (EASI) Patient Oriented Eczema Measure (POEM) Dermatology Life Quality Index (DLQI) and Peak Pruritus Numeric Rating Scales (PP-NRS). Results Since October 2019 21 new studies were added for a total of 60 trials with 16 579 patients. Up to 16 weeks of treatment in adults abrocitinib 200 mg daily (mean difference [MD] 2.2; 95% credible interval [CrI] 0.2-4.0; high certainty) and upadacitinib 30 mg daily (MD 2.7; 95% CrI 0.6-4.7; high certainty) were associated with reduced EASI slightly more than dupilumab 600 mg then 300 mg every 2 weeks. Abrocitinib 100 mg daily (MD -2.1; 95% CrI -4.1 to -0.3; high certainty) baricitinib 4 mg daily (MD -3.2; 95% CrI -5.7 to -0.8; high certainty) baricitinib 2 mg daily (MD -5.2; 95% CrI -7.5 to -2.9; high certainty) and tralokinumab 600 mg then 300 mg every 2 weeks (MD -3.5; 95% CrI -5.8 to -1.3; high certainty) were associated with reduced EASI slightly less than dupilumab. There was little or no difference between upadacitinib 15 mg daily and dupilumab (MD 0.2; 95% CrI -1.9 to 2.2; high certainty). The pattern of results was similar for POEM DLQI and PP-NRS. Conclusions and Relevance In this systematic review and meta-analysis abrocitinib 200 mg; and upadacitinib 30 mg daily were associated with slightly better scores than dupilumab and upadacitinib 15 mg daily was associated with similar scores to dupilumab. Abrocitinib 100 mg daily baricitinib 4 mg and 2 mg daily and tralokinumab 300 mg every 2 weeks were associated with slightly worse scores.
Published: 2022-03-16
Journal: JAMA dermatology
DOI: 10.1001/jamadermatol.2022.0455
Author Name: Drucker Aaron M
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Author Name: Morra Deanna E
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Author Name: Prieto Merino David
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Author Name: Ellis Alexandra G
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Author Name: Yiu Zenas Z N
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Author Name: Rochwerg Bram
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Author Name: Di Giorgio Sonya
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Author Name: Arents Bernd W M
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Author Name: Burton Tim
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Author Name: Spuls Phyllis I
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Author Name: Schmitt Jochen
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Author Name: Flohr Carsten
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license: unk
license_url: [unknown license]
source_x: Medline
pubmed_id: 35293977
has_full_text: FALSE
G_ID: systemic_immunomodulatory_treatments_for_atopic_dermatitis_update_of_a_living_systematic