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JAK inhibitors and dupilumab, alone and in combination with topical corticosteroids, were the most promising treatments for moderate to severe atopic dermatitis (AD) after 16 weeks of therapy, according to a systematic review and meta-analysis published in Acta Dermato-Venereologica.
Investigators conducted a systemic literature search for phase 2 and 3 clinical studies in English that compared monoclonal antibodies or Janus kinase (JAK) inhibitors for treatment of AD with at least 10 adult patients in each treatment group. Trials also needed to include a placebo group, provide detailed information on the percentage of patients achieving 50, 75, and 90% improvement in Eczema Area Severity Index (EASI) scores, respectively, and could not investigate topical treatments in combination with monoclonal and JAK inhibitors. The primary outcomes were the percentage of patients achieving EASI 50, 75, and 90, respectively. Meta-analyses for efficacy outcomes were conducted using random-effects models when statistically appropriate, using risk difference (RD) as the outcome measure for binary outcomes.
There were 19 studies included in the review. Regarding EASI-50 outcomes, monotherapy with upadacitinib 30 mg once daily and dupilumab 200 mg once weekly showed comparable results after treatment for 16 weeks (upadacitinib RD: 59%; dupilumab RD: 56%). Abrocitinib 200 mg once daily for 16 weeks (RD, 52%) was almost as effective as dupilumab 300 mg once weekly for 12 weeks (RD, 50%). When combined with topical corticosteroids (TCS), dupilumab 300 mg every 2 weeks was comparable to 300 mg weekly after 16 weeks of treatment. Researchers found that abrocitinib 200 mg once daily for 12 weeks combined with TCS was highly effective compared to other treatments.
Regarding EASI-75 outcomes, monotherapy with upadacitinib 30 mg once daily and dupilumab 200 mg once weekly showed comparable results (upadacitinib: RD 59%; dupilumab: RD, 52%) compared with placebo groups. Similar trends were seen with abrocitinib 200 mg once daily and dupilumab 200 mg every 2 weeks. When combined with TCS, abrocitinib 200 mg once daily was found to be superior to other treatments after 12 weeks of therapy.
For EASI-90 monotherapy outcomes, upadacitinib 30 mg once daily for 16 weeks was more effective than placebo, and abrocitinib 200 mg once daily and dupilumab 200 mg once weekly were comparable after 16 weeks of treatment. When combined with TCS, abrocitinib 200 mg once daily was noted by investigators to be superior to other treatments after 12 weeks of therapy. TCS and dupilumab 300 mg every 2 weeks was comparable to 300 mg every week after 16 weeks of therapy.
The study was limited in that upadacitinib was only studied as monotherapy and not in combination with TCS, and the short-term duration of therapy included in the study.
Based on the results of this review, the study authors recommended “treatment with upadacitinib 30 mg once daily as monotherapy” for the greatest efficacy regarding EASI-50, 75 and 90, adding that “dupilumab seems to be most effective when in combination therapy with TCS.”
Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Sedeh FB, Henning MAS, Jemec GBE, Ibler KS. Comparative efficacy and safety of monoclonal antibodies and janus kinase inhibitors in moderate-to-severe atopic dermatitis: a systematic review and meta-analysis. Acta Derm Venereol. Published online August 24, 2022. doi:10.2340/actadv.v102.2075
