Atopic dermatitis: 2 systemic therapies stand above the rest

  • Seger EW & al.
  • J Am Acad Dermatol
  • 5 Oct 2018

  • curated by Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 41 studies including 4938 patients and 17 medications were analyzed for efficacy of systemic treatments.
  • Funding: None.

Limitations

  • An overall lack of well-controlled comparison studies.

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