Review Finds Abrocitnib, Upadacitinib Superior to Dupilumab

Aaron M. Drucker, MD

A new systematic review of several systemic immunomodulatory treatments for atopic dermatitis (AD) found that abrocitnib 200 mg and upadacitinib 20 mg daily were associated with slightly better scores than dupilumab.

Additionally, upadacitinib 15 mg daily was associated with similar scores to dupilumab while brocitinib 100 mg daily, baricitinib 4 mg and 2 mg daily, and tralokinumab 300 mg every 2 weeks were associated with slightly worse scores.

Investigators noted that the lack of head-to-head trials for these medications has proved difficult in making direct comparisons of efficacy and safety.

A previously published network meta-analysis had found that dupilumab might have similar efficacy to higher-dose cyclosporine, and was superiorro to methotrexate and azathioprine.

New trials have been published since the publication of the initial review, which prompted investigators led by Aaron M. Drucker, MD, Department of Medicine at the University of Toronto, Canada, to update their living systematic review and network meta-analysis.

The Methods

Drucker and colleagues searched for new studies via the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Embase, Latin American and Caribbean Health Science Information database (LILACS), and the Global Resource of EczemA Trials (GREAT) database, and several other clinical databases across the globe.

They included studies with children and adults with moderate to severe AD treatef for 8 weeks or longer and at least 2 doses of systemic immunomodulatory therapies with any comparator. Additionally, trials that allowed or disregarded adjunctive topic anti-inflammatory therapies were also included.

Outcomes were changes in investigator-reported clinical signs, prioritizoing the EASI, patient-reported symptoms, and PP-NRS.

The updated analysis was completed from June to December 2021.

The Findings

Since October 2019, a total of 21 new studies were included. In total, 60 trials with 16,579 patients were included in the new review.

Regarding 16 weeks of treatments in adults, abrocitinib, 200 mg daily (mean difference [MD], 2.2; 95% credible interval [CrI], 0.2-4.0; high certainty) and upadacitinib, 30 mg daily (MD, 2.7; 95% CrI, 0.6-4.7; high certainty) were associated with reduced EASI slightly more than dupilumab, 600 mg then 300 mg every 2 weeks.

Conversly, abrocitinib, 100 mg daily (MD, −2.1; 95% CrI, −4.1 to −0.3; high certainty), baricitinib, 4 mg daily (MD, −3.2; 95% CrI, −5.7 to −0.8; high certainty), baricitinib, 2 mg daily (MD, −5.2; 95% CrI, −7.5 to −2.9; high certainty) and tralokinumab, 600 mg then 300 mg every 2 weeks (MD, −3.5; 95% CrI, −5.8 to −1.3; high certainty) were associated with reduced EASI slightly less than dupilumab.

Investigators observed little or no difference between upadacitinib, 15 mg daily, and dupilumab (MD, 0.2; 95% CrI, −1.9 to 2.2; high certainty).

“Our results may aid shared decision-making between clinicians and patients seeking to understand the relative merits of different treatment options for moderate-to-severe atopic dermatitis,” the team wrote.

The study, "Systemic Immunomodulatory Treatments for Atopic DermatitisUpdate of a Living Systematic Review and Network Meta-analysis," was published online in JAMA Dermatology.