Relative efficacy of systemic treatments for atopic dermatitis

BACKGROUND: Systemic medications are often required for severe atopic dermatitis (AD) refractory to topical therapies. Biologic medications are a recent advancement in the field and a comparison with standard systemic approaches would be beneficial.

OBJECTIVE: To compare efficacies of systemic therapies for the treatment of AD.

METHODS: A systematic literature review was performed using Medline, Ovid, and Embase. Randomized controlled trials looking at the efficacy of systemic treatments for AD in adults and children were included.

RESULTS: A total of 41 studies met criteria and were included in our final analysis. Consistent improvements in Eczema Area and Severity Index and Scoring Atopic Dermatitis were reported with dupilumab and cyclosporine. Phase 2 clinical trials for lebrikizumab and tralokinumab were effective and would benefit from phase 3 trials. No study reported efficacy of biologic medications in pediatric patients; however, cyclosporine improved clinical severity by the greatest amount in this group.

LIMITATIONS: A lack of well controlled comparison studies make direct comparisons between the treatments difficult.

CONCLUSION: For treatment of severe AD, the strongest evidence currently exists for dupilumab and cyclosporine at improving clinical disease severity. Further research is required to determine long-term safety and efficacy of biologic medications.

KEYWORDS: adults; atopic dermatitis; biologic treatment; children; cyclosporine; dupilumab; efficacy; lebrikizumab; systemic treatment; tralokinumab