Efficacy of omalizumab in patients with atopic dermatitis: A systematic review and meta-analysis

Abstract

Omalizumab has been used to treat patients with atopic dermatitis (AD) with controversial results. 1 Our objective was to perform a systematic review and meta-analysis to investigate the efficacy of omalizumab and the factors associated with better therapeutic results in patients with AD.The search included PubMed, MEDLINE, EmBase, and the Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Controlled Trials Register, and Health Technology Assessment Databases) from inception to November 30, 2015, using the search terms atopic dermatitis or eczema combined with omalizumab. Only human clinical studies written in English were included in this analysis. This literature search focused on randomized controlled trials (RCTs), comparative studies, and case series in which 3 or more patients with AD received omalizumab treatment. Review articles, single case reports, guidelines, consensus manuscripts, and correspondence were excluded. The primary outcome assessed was the clinical response of omalizumab in patients with AD.Data on the following measures were extracted: study design, sample size, trial duration, treatment regimen, and author's conclusion (Table I). For studies that provided the patients' raw data (detailed information for each patient), data on patients' age, sex, asthma history, pretreatment IgE concentration, pretreatment and posttreatment severity of eczema (using Severity Scoring of Atopic Dermatitis [SCORAD], Eczema Area and Severity Index [EASI], or Investigators' Global Assessment [IGA] scores), clinical response, adverse event, and treatment duration were collected (Table II). The dosing regimens were divided into 2 groups on the basis of total dosage of the month: 600 mg/month or more (eg, 300 mg omalizumab subcutaneously in 2-week intervals or 150 mg in a 1-week interval) or less than 600 mg/month (eg, 150 mg omalizumab subcutaneously in 2-week intervals or 300 mg in 3-week interval). We then performed multivariate logistic regression on the detailed data to evaluate the possible factors associated with an excellent clinical response. Values of P less than .05 were considered statistically significant. Statistical analysis was performed using PASW Statistics 18.0.An excellent clinical response was defined as a SCORAD reduction of more than 50%, or an EASI reduction of more than 75% or total clearance (improvement to IGA 0), or an improvement of 2-degree or more in IGA/modified IGA severity (eg, severe to mild). Satisfying clinical response was a SCORAD reduction between 25% and 50%, or an EASI reduction between 25% and 50%, or a 1-degree improvement in IGA/

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