In the scarcity of head‐to‐head studies of systemic therapies in moderate‐to‐severe atopic dermatitis (AD), network meta‐analyses (NMAs) can furnish comparative efficacy and safety data to inform clinical decision‐making. 

A recent NMA identified the eligible randomized controlled trials (RCTs) published by a systematic literature review. It abstracted the short‐term (12-16 weeks) efficacy (Investigators Global Assessment [IGA] and Eczema Area and Severity Index [EASI] responses), patient‐reported outcomes (PROs) and safety data from each trial. It then analyzed them separately for monotherapy and combination therapy (systemic plus topical anti‐inflammatory therapy) in fixed‐effects and random‐effects Bayesian NMA models. 

• The NMA included 19 (phase 2 and 3) RCTs of abrocitinib, baricitinib, dupilumab, lebrikizumab, nemolizumab, tralokinumab and upadacitinib.
• In monotherapy RCTs, upadacitinib 30 mg once daily (QD) demonstrated the numerically highest efficacy and EASI‐50 response, followed by abrocitinib 200 mg QD, upadacitinib 15 mg QD, dupilumab 300 mg every 2 weeks (Q2W) and abrocitinib 100 mg QD. EASI‐75 and EASI‐90 responses also showed similar trends.
• In combination therapy RCTs, abrocitinib 200 mg QD demonstrated the highest EASI‐50, followed by dupilumab 300 mg Q2W and abrocitinib 100 mg QD. IGA response and PROs also showed similar findings.
• Among all RCTs, the probability of treatment‐emergent adverse events (TEAEs) was higher in all active treatments than with placebo (except for dupilumab 300 mg Q2W and abrocitinib 100 mg QD in combination therapy RCTs). However, there were no significant differences between the active treatments. 

Thus, abrocitinib, dupilumab and upadacitinib have invariably been the most effective systemic therapies in adult and adolescent patients with AD, with no significant TEAE differences in short‐term RCTs.

Source: Silverberg JI, Thyssen JP, Fahrbach K, et al. Comparative efficacy and safety of systemic therapies used in moderate-to-severe atopic dermatitis: a systematic literature review and network meta-analysis. J Eur Acad Dermatol Venereol. 2021;35(9):1797-810.