Comparative Efficacy of Systemic Treatments for Adult Atopic Dermatitis

Conclusions

• Network meta-analysis suggests that among older systemic treatments for adult atopic dermatitis, cyclosporine is the most effective short-term option, with methotrexate and azathioprine also effective but generally less potent.
• Across newer targeted therapies, the differences in efficacy are often small, but high-dose JAK inhibitors—especially upadacitinib 30 mg and abrocitinib 200 mg—tend to be the most effective.
• Lower-dose JAK inhibitor regimens appear closer in efficacy to dupilumab, supporting dose escalation strategies rather than automatic high-dose initiation.
• Among biologics, lebrikizumab appears broadly similar to dupilumab, while tralokinumab and nemolizumab are likely somewhat less effective on most measures.
• Nemolizumab may perform relatively better for itch specifically than for overall skin clearance or other disease outcomes.
• The overall ranking of treatments is broadly consistent across different outcome measures, including EASI, EASI-75, symptom scores, and quality-of-life measures.
• The pattern of comparative efficacy is similar whether trials include topical co-therapy or are monotherapy trials, suggesting the main conclusions are robust.
• Head-to-head trials have largely confirmed the network meta-analysis findings, particularly that high-dose JAK inhibitors outperform dupilumab but not by a dramatic margin.
• Short-term trial results at 16 weeks are informative, but emerging long-term data suggest some treatments may continue improving beyond that timepoint.
• Treatment choice should not be based on efficacy alone, because safety, age, comorbidities, cost, access, monitoring burden, and patient preference remain important in selecting systemic therapy.