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Most Effective Atopic Dermatitis Treatments May Also Be Most Harmful

AAAAI News Release

February 5, 2024

Candace Archie, Communications & Public Relations Manager
(414) 272-6071

New research aids physicians in selecting best option for patients.

MILWAUKEE (February 5, 2024) – The most effective treatment for improving outcomes for patients with atopic dermatitis may also be the riskiest, however the effectiveness of competing treatments varies according to new research being presented at the 2024 American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting.
"Atopic dermatitis is the most common inflammatory skin condition with an increasing number of available systemic interventions. We systematically reviewed and meta-analyzed the comparative benefits and harms of the available options and appraised the evidence using robust and standardized approaches. Our findings have important and immediate implications for achieving optimal outcomes in patients with eczema requiring advanced therapy" says primary author Alexandro Chu, BHSc.
Competing treatment options exist for atopic dermatitis, but uncertainty regarding their comparative effectiveness still remains, the study showed. Researchers examined the benefits and harms of all systemic and phototherapy treatments for atopic dermatitis in this network meta-analysis.

In randomized, controlled trials addressing systemic and phototherapy treatments for atopic dermatitis from MEDLINE, EMBASE, CENTRAL, Web of Science and GREAT, researchers performed Bayesian random-effects network meta-analyses on atopic dermatitis severity, itch severity, sleep disturbance, quality of life, exacerbations and adverse events. Thresholds for patient-important benefits and harms were pre-determined with a multidisciplinary panel that included patient partners.

Researchers analyzed 154 trials enrolling 29,831 patients, both children and adults, and evaluated 78 unique interventions over a median 13 weeks. The analysis found that high-dose upadacitinib was among the most effective treatments in improving multiple patient outcomes, but it was also among the most harmful in increasing any adverse event. High-dose abrocitinib and low-dose upadacitinib provided intermediate effectiveness but were also among the most harmful. Dupilumab, lebrikizumab and tralokinumab were generally of intermediate effectiveness and among the safest but modestly increased the frequency of conjunctivitis. Low dose baricitinib was among the least effective across all outcomes. The benefits and harms of azathioprine, oral corticosteroids, cyclosporine, methotrexate, mycophenolate, phototherapy and many novel agents were less certain.  

The findings are robust to subgroup and sensitivity analyses and provide insight into the use and effectiveness of available atopic dermatitis treatments, helping physicians and patients choose the best treatment option available.  

Visit to learn more about atopic dermatitis. Research presented at the 2024 AAAAI Annual Meeting, February 23-26 in Washington, DC, is published in an online supplement to The Journal of Allergy and Clinical Immunology.

The American Academy of Allergy, Asthma & Immunology (AAAAI) is the leading membership organization of more than 7,100 allergists, asthma specialists, clinical immunologists, allied health professionals and other professionals with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has more than 7,100 members in the United States, Canada and 72 other countries and is the go-to resource for patients living with allergies, asthma and immune deficiency disorders.