Systemic immunomodulatory treatments for atopic dermatitis: protocol for a systematic review with network meta-analysis

Abstract

IntroductionThere are numerous new systemic treatments for atopic dermatitis in various stages of development and most are being compared with placebo rather than active comparators. In order to understand the relative efficacy and safety of existing and new treatments for atopic dermatitis, robust mixed comparisons (ie, direct and indirect) would be beneficial. To address this gap, this protocol describes methods for a systematic review and network meta-analysis of systemic treatments for atopic dermatitis.Methods and analysisWe will update the search of a previous systematic review, including searches of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Latin American and Caribbean Health Science Information database and the Global Resource of EczemA Trials database in addition to clinical trial protocol registries. Title, abstract and full paper screening as well as data extraction will be conducted in duplicate by independent researchers. Primary outcomes include efficacy with regards to clinician-reported signs and patient-reported symptoms and safety with regards to withdrawal from treatment due to adverse events and the occurrence of serious adverse events. Secondary outcomes will include change in quality of life and itch severity. Where possible and appropriate, network meta-analysis will be performed for each outcome using a random-effects model within a Bayesian framework. If appropriate, the review will be transitioned to a living review with continuous updating of the analysis.Ethics and disseminationDissemination in a peer-reviewed scientific journal is planned.PROSPERO registration numberCRD42018088112; Pre-results.

Efficacy and safety of dupilumab for moderate-to-severe atopic dermatitis: a systematic review for the EAACI Biologicals Guidelines

“…This SR is the most up to date review on the effectiveness, safety and economic impact on dupilumab in AD. Similar to previous SRs the current analysis reinforces the short-term (16 weeks) efficacy of dupilumab in improving SCORAD, EASI, IGA, pruritus, and quality of life (49,50,51). In addition, the current SR provides evidence for long-term (52 weeks) benefit in adults.…”

The European TREatment of ATopic eczema (TREAT) Registry Taskforce survey: prescribing practices in Europe for phototherapy and systemic therapy in adult patients with moderate‐to‐severe atopic eczema*

“…More high‐quality evidence is needed. Large, well‐designed prospective patient cohorts (for real‐life data) or (living) network meta‐analyses24 might provide the data that are needed, and might provide guidance on the treatment of subgroups, for example. The TREAT Registry Taskforce25 has developed a core dataset that can aid in gathering comparable data26,27 and that is already used in many national research registries (https://treat-registry-taskforce.org/).…”

Atopic dermatitis in adults: An Australian management consensus

“…Approved systemic treatment options in patients with moderate–severe disease are limited, with many medications being used off‐label. A review is currently underway with the aim of providing a comprehensive, comparative evaluation of systemic treatments in AD including ciclosporin, methotrexate, azathioprine, mycophenolate, corticosteroids, interferon‐gamma, intravenous immunoglobulin, dupilumab and other novel systemic agents . Recognising that current data are limited, and that new treatment options are becoming available, several recommendations were made regarding potential treatment pathways with regard to systemic therapies (Fig.…”