Comparative Efficacy and Safety of Monoclonal Antibodies and Janus Kinase Inhibitors in Moderate-to-severe Atopic Dermatitis: A Systematic Review and Meta-analysis

Abstract

The aim of this study was to compare the efficacies of systemic treatments with dupilumab, tralokinumab and Janus kinase inhibitors for moderate-to-severe atopic dermatitis. A systematic review following Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines was performed using Medline, EMBASE and Cochrane library. All randomized controlled trials investigating the efficacy of systemic treatments for moderate-to-severe atopic dermatitis in adults were included. Primary outcomes were the proportion of patients with atopic dermatitis achieving 50%, 75%, and 90% improvement in Eczema Area and Severity Index (EASI) score after dupilumab, tralokinumab or Janus kinase inhibitors. Nineteen studies totalling 6,444 patients were included. In monotherapy studies, upadacitinib 30 mg once daily had the numerically highest efficacy regarding EASI-50, EASI-75 and EASI-90. In combination therapy studies with topical corticosteroids, dupilumab 300 mg once every other week had highest efficacy regarding EASI-50, and abrocitinib 200 mg once daily had the highest score regarding EASI-75 and EASI-90. Analysis provided evidence that dupilumab, tralokinumab and Janus kinase inhibitors all had an acceptable efficacy profile and resulted in clinically relevant improvements in EASI score. Furthermore, upadacitinib and abrocitinib seem to have great potential to treat patients with atopic dermatitis. However, further studies are needed to determine the long-term efficacy of Janus kinase inhibitors in adults with moderate-to-severe atopic dermatitis.

Non‐biologic systemic treatments for atopic dermatitis: Current state of the art and future directions

“…In monotherapy studies, upadacitinib 30 mg once daily had the numerically highest efficacy regarding EASI‐50, EASI‐75 and EASI‐90. In combination therapy studies with topical corticosteroids, dupilumab 300 mg once every other week had the highest efficacy regarding EASI‐50 and abrocitinib 200 mg once daily had the highest score regarding EASI‐75 and EASI‐90 57 …”

Guía de dermatitis atópica para México (GUIDAMEX): lineamientos usando metodología ADAPTE

“…Desde el año pasado se han publicado revisiones sistemáticas con metaanálisis, basadas en ensayos clínicos aleatorizados sobre efectividad y seguridad de iJAK en DA (Siegels et al 2021 83 y Sedeh et al 2022 103 ) además de estudios específicos a largo plazo para cada molécula 104,105 .…”

The efficacy and safety of lebrikizumab monotherapy for the management of moderate-to-severe atopic dermatitis: A systematic review and meta-analysis

“…Janus kinase (JAK) inhibitors and monoclonal immunomodulators such as abrocitinib, a JAK1 inhibitor, and dupilumab, an IL-4 inhibitor, were recently established as effective treatments and have received the US Food and Drug Administration (FDA) approval for managing moderate-to-severe AD. JAK inhibitors are mostly for oral use and one of which, tofacitinib, is additionally used as a topical off-label option ( 6 ). Dupilumab was approved by the FDA in 2017 and set the stage for more IL immunomodulators to emerge ( 6 , 7 ).…”

“…JAK inhibitors are mostly for oral use and one of which, tofacitinib, is additionally used as a topical off-label option ( 6 ). Dupilumab was approved by the FDA in 2017 and set the stage for more IL immunomodulators to emerge ( 6 , 7 ). Tralokinumab and lebrikizumab are the latest drugs attempting to target IL-13 to minimize AD signs and symptoms ( 8 ).…”