Upadacitinib, abrocitinib, and dupilumab were the most effective systemic treatments for moderate to severe atopic dermatitis (AD) compared with baricitinib, lebrikizumab, nemolizumab, and tralokinumab, according to study results presented at the American Academy of Dermatology’s Virtual Meeting Experience (AAD VMX) 2021, held online from April 23 to April 25, 2021.
The study findings were from a systematic literature review and network meta-analysis of 19 published phase 2 and 3 randomized controlled trials featuring adults and adolescents with moderate to severe AD. The investigators analyzed short-term efficacy of these therapies (ie, between 12-16 weeks) using the Eczema Area and Severity Index (EASI) and the Investigator’s Global Assessment scale (IGA) responses. Safety data were also evaluated for both monotherapy and combination regimens.
Monotherapy trials showed that treatment with once-daily 30 mg upadacitinib was associated with a higher percentage of patients who achieved a 90% or greater improvement in EASI (EASI-90) (51.6%). This efficacy was followed by once-daily 200 mg abrocitinib (39.2%), once-daily 15 mg upadacitinib (34.5%), 300 mg dupilumab every 2 weeks (27.6%), and abrocitinib 100 mg once-daily (22.2%).
In trials that examined combination systemic therapy, once-daily 200 mg abrocitinib demonstrated the highest efficacy in terms of achievement of the EASI-90 (48.7%), followed by 300 mg dupilumab every 2 weeks (41.7%) and once-daily 100 mg abrocitinib (37.9%). The investigators reported similar findings in these trials for IGA response and patient-reported outcomes.
The probability of treatment-emergent adverse events (TEAEs) in a pooled analysis of monotherapy and combination therapy trials was higher for all active treatments compared with control except for 300 mg dupilumab every 2 weeks (odds ratio [OR], 0.96; 95% CrI, 0.45-2.18) and once-daily 100 mg abrocitinib (OR, 0.95; 95% CrI, 0.35-2.66) in combination studies. Despite these differences, the adverse event incidence was similar with active treatments, it was noted.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. This research was funded by Pfizer, Inc.
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Silverberg JI, Thyssen JP, Fahrbach K, et al. Comparative efficacy and safety of systemic therapies used in adult and adolescent moderate-to-severe atopic dermatitis (AD): A systematic literature review and network meta-analysis. Presented at: AAD VMX 2021; April 23-25, 2021. Abstract/Poster 27533.