Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Comparative Efficacy of Systemic Treatments for Atopic Dermatitis in Adults
Description
The presentation discusses the advancements in systemic treatments for adult atopic dermatitis over the past eight years, highlighting a significant increase in new therapies, including biologics and JAK inhibitors, prominently since the approval of dupilumab in 2017. With the latest updates to the AAD clinical guidelines, several new drugs have been recognized, providing clinicians with a variety of options supported by stronger evidence than before. Key factors for treatment choice include efficacy, long-term safety, individual patient characteristics, costs, and insurance coverage. The speaker emphasizes the challenge of comparing efficacy due to variable placebo responses in clinical trials for atopic dermatitis, contrasting it to psoriasis where benchmarking was straightforward. Using network meta-analysis, the speaker assessed the relative efficacy of different treatments, indicating that high-dose JAK inhibitors like upadacitinib and abrocitinib demonstrate higher efficacy compared to dupilumab, which is now a gold standard. The presentation concludes that while more potent treatments are available, considerations like patient response and safety profiles should guide selection, with ongoing discussions about the complexities and nuances of each treatment option.
View moreConclusions
- There are now multiple effective systemic treatment options available for adults with atopic dermatitis, enhancing treatment flexibility.
- Network meta-analysis can aid in comparing relative efficacy among different treatments for atopic dermatitis.
- High-dose JAK inhibitors like abrocitinib and upadacitinib show superior efficacy compared to dupilumab, particularly in achieving EASI-75 responses.
- Lower doses of JAK inhibitors offer efficacy similar to that of dupilumab, making dose escalation a viable strategy.
- Older treatments like cyclosporine, methotrexate, and azathioprine remain effective, but their efficacy may be less precise than new therapies.
- Factors such as patient age, preferences, and medication costs should be considered when selecting a treatment approach.
- Tralokinumab and nemolizumab are likely less effective than dupilumab, while lebrikizumab is closer to dupilumab's efficacy.
- Shared decision-making is crucial in determining the best treatment approach for individual patients.
- Davis DMR, Drucker AM et al. JAAD. 2024;90:e43-e56.
- Ann Allergy Asthma Immunol. 2024. 132: 274-312.
- Watt ... Drucker. J Invest Dermatol. 2019 Jan;139(1):4-12.e1.
- Drucker et al. JAMA Dermatol. 2020 Jun 1;156(6):659-667.
- Blauvelt A, Teixeira HD, Simpson EL, et al. Efficacy and safety of upadacitinib vs dupilumab in adults with moderate-to-severe atopic dermatitis: a randomized clinical trial. 10.1056/NEJMoa2019380.
- Silverberg et al. Br J Dermatol. 2025;192:36-45.
- American Journal of Clinical Dermatology (2024) 25:179-193. https://doi.org/10.1007/s40257-023-00837-w