- A systematic review suggests that dupilumab and cyclosporine have the strongest evidence for improving clinical disease severity in patients with severe atopic dermatitis (AD).
Why this matters
- This systematic review attempts to address the lack of head-to-head trials comparing systemic AD treatments.
- In adults, the largest improvements in clinical severity were seen with cyclosporine and dupilumab:
- 8 weeks of cyclosporine was associated with 68%-69% (4-4.5 mg/kg/day twice daily) or 44% (2.5 mg/kg/day) improvement in Six Area Six Sign Atopic Dermatitis (SASSAD) score.
- 5 mg/kg/day cyclosporine was associated with 56% improvement in Scoring Atopic Dermatitis (SCORAD) at week 24.
- Dupilumab was associated with 76% improvement in Eczema Area and Severity Index at week 16.
- 1 year of dupilumab was associated with a 66% reduction in SCORAD.
- In children, cyclosporine was associated with a 46% reduction in SASSAD at week 12 in a non-placebo-controlled study, but no difference in SCORAD score vs methotrexate at week 12.
- In children, flunisolide improved total clinical severity scores by 54% in a 2-week placebo-controlled trial.
- 41 studies including 4938 patients and 17 medications were analyzed for efficacy of systemic treatments.
- Funding: None.
- An overall lack of well-controlled comparison studies.