Most Effective Atopic Dermatitis Treatments May Pose Greatest Risk of Adverse Events

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Although certain treatments such as high-dose upadacitinib are notably efficacious for patients with atopic dermatitis, new findings suggest that many of these same treatments could pose a greater risk for adverse events.¹

These findings, set to be shown at the 2024 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting, demonstrated that some of the most effective treatments for improving eczema outcomes may also be the riskiest. Eczema and atopic dermatitis are here referred to interchangeably.

"Atopic dermatitis is the most common inflammatory skin condition with an increasing number of available systemic interventions,” the study’s primary author Alexandro Chu, BHSc, said in a statement. “We systematically reviewed and meta-analyzed the comparative benefits and harms of the available options and appraised the evidence using robust and standardized approaches.”

Chu also noted in his statement that his team’s results represent several implications for the achievement of optimal outcomes for those with atopic dermatitis in need of advanced therapies.

While there are competing treatments for eczema in existence, Chu and colleagues’ research The investigators utilized both a systematic review and a meta-analysis to look into the drawbacks and the benefits of systemic and phototherapy treatments for individuals dealing with eczema.

The investigators’ comprehensive assessment had included several different disease parameters such as severity, exacerbations, disturbances with sleep, severity of pruritus, life quality, and adverse events. The team conducted Bayesian random-effects network meta-analyses through the use of randomized controlled trial data that had been drawn from several different databases.

The research team looked at 154 studies which had involved 29,831 participants, including both adults and children. The team also assessed 78 distinct interventions which had been done for eczema patients over a median duration of 13 total weeks.

Overall, the investigators reported that their analysis revealed a higher-dose upadacitinib treatment to be 1 of the most effective atopic dermatitis therapies in several different outcomes. They did add, however, that it was also linked to increases in adverse event risks.

In a similar vein, the same increases in adverse event risk were also seen with the higher doses of abrocitinib and low-doses of upadacitinib, though their intermediate effectiveness was also high. In contrast, the research team noted that lebrikizumab, dupilumab, and tralokinumab showed intermediate efficacy and lower risk profiles at the same time, though there was a small conjunctivitis frequency rise.

The team also reported that low-dose baricitinib was shown to be 1 of the least efficacious eczema treatments across all of the outcomes they had assessed. Despite their conclusions, the investigators remained uncertain about the comparative drawbacks and benefits of other atopic dermatitis treatments.

Some of these treatments which remained less well-defined by the research team included oral corticosteroids, azathioprine, methotrexate, cyclosporine, phototherapy, mycophenolate, and novel agents.

The findings in the investigators’ subgroup and sensitivity analyses were notably robust, however, and they were noted as having provided several useful conclusions for clinicians as well as patients. Such findings may contribute to dermatologists’ choices of the most ideal treatment option for patients with atopic dermatitis.

Discussions among dermatologists on the benefits and drawbacks of different therapies—culminating in comparisons by clinicians such as this recent example by Lawrence Eichenfield, MD—represent explorations of invaluable topics for patients and clinicians alike.²

References

1. ^{Most Effective Atopic Dermatitis Treatments May Also Be Most Harmful. American Academy of Allergy, Asthma & Immunology. February 5, 2024. https://www.aaaai.org/about/news/news/2024/atopic#:~:text=The%20analysis%20found%20that%20high,also%20among%20the%20most%20harmful. Date accessed: February 21, 2024.}
2. ^{Smith T. Lawrence Eichenfield, MD: Comparing Ruxolitinib, Other Atopic Dermatitis Treatments. HCPLive. November 30, 2023. https://www.hcplive.com/view/lawrence-eichenfield-comparing-ruxolitinib-other-atopic-dermatitis-treatments. Date accessed: February 21, 2024.}