Meta-Analysis Finds Dupilumab Has Most Evidence of Effectiveness for Treating Atopic Dermatitis

A recent study in The American Journal of Clinical Dermatology led by Igor Snast, MD, sought to evaluate the efficacy and safety of biologic agents in the treatment of atopic dermatitis (AD). The results of the study showed that in particular, dupilumab stood out.

AD is the most common form of eczema. Approximately 10% to 20% of children aged 10 and younger in the United States develop AD, as do 1% to 3% of adults around the world. In the United States alone, AD affects at least 28 million people of all ages. Effective treatment often requires a multifaceted approach that includes medication, proper skin care, trigger avoidance, and coping mechanisms.

Biologics may be able to address the unmet need for improved AD therapeutics. Current systematic treatments that are in place for AD offer limited efficacy and are often restricted by safety concerns, according to the study.

Researchers constructed a systematic review and meta-analysis of studies evaluating AD patients that were treated with biologics. The primary outcome was the Eczema Area and Severity Index (EASI)-75 response, while secondary outcomes were SCORing Atopic Dermatitis (SCORAD)-75, EASI-50, SCORAD-50 Investigator Global Assessment 0/1 responses, change in responses from baseline, and adverse events.

Included in the meta-analysis were 13 randomized controlled trials (RCTs) and 10 observational studies that evaluated 9 biologics. High-quality evidence was available for dupilumab, nemolizumab, and ustekinumab.

In combing these 5 studies, at weeks 12-16, dupilumab 300mg given every 1-2 weeks achieved EASI-75 that were 55% superior to placebo (relative risk [RR] 3.3, 95% CI, 2.9-3.6). Nemolizumab had similar EASI-75 responses as placebo, but significantly improved pruritus.

In online reports, lebrikizumab demonstrated superior EASI-50 responses versus placebo (RR 1.3, 95% CI, 1.04-1.7), while tralokinumab had superior SCORAD-50 responses versus placebo, with borderline significance (RR 1.7, 95% CI, 0.97-3.1). In two RCTs each, omalizumab and ustekinumab were comparable with placebo, while antithymic stromal lymphopoietin receptor, infliximab, and rituximab lacked adequate evidence of efficacy. All medications had a comparable safety profile to that of the placebo.

The results of the study show that at present, dupilumab is the only biologic with significant evidence of efficacy in AD. Nemolizumab, lebrikizumab, and tralokinumab show promise, but further research will need to be done to determine efficacy.

Reference

Snast I, Reiter O, Hodak E, et al. Are biologics efficacious in atopic dermatitis? A systematic review and meta-analysis [published online November 2, 2017]. Am J Clin Dermatol. 2017; https://doi.org/10.1007/s40257-017-0324-7.