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American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 2/2018

01-04-2018 | Systematic Review

Are Biologics Efficacious in Atopic Dermatitis? A Systematic Review and Meta-Analysis

Authors: Igor Snast, Ofer Reiter, Emmilia Hodak, Rivka Friedland, Daniel Mimouni, Yael Anne Leshem

Published in: American Journal of Clinical Dermatology | Issue 2/2018

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Abstract

Background

Current systemic treatments for atopic dermatitis (AD) offer limited efficacy and are often restricted by safety concerns. Biologics may address the unmet need for improved AD therapeutics.

Objective

The aim of this study was to evaluate the efficacy and safety of biologic agents in AD.

Methods

A systematic review and meta-analysis of studies evaluating AD patients treated with biologics was performed. The primary outcome was the Eczema Area and Severity Index (EASI)-75 response, while secondary outcomes were SCOring Atopic Dermatitis (SCORAD)-75, EASI-50, SCORAD-50, Investigator Global Assessment 0/1 responses, change in responses from baseline, and adverse events.

Results

We included 13 randomized controlled trials (RCTs) and 10 observational studies evaluating nine biologics. High-quality evidence was available for dupilumab, nemolizumab and ustekinumab. Pooling five studies, at weeks 12–16 dupilumab 300 mg every week to every 2 weeks achieved EASI-75 responses of 55%, superior to placebo [relative risk (RR) 3.3, 95% confidence interval (CI) 2.9–3.6]. Nemolizumab had similar EASI-75 responses as placebo, but significantly improved pruritus. In online reports, lebrikizumab demonstrated superior EASI-50 responses versus placebo (RR 1.3, 95% CI 1.04–1.7), while tralokinumab had superior SCORAD-50 responses versus placebo, with borderline significance (RR 1.7, 95% CI 0.97–3.1). In two RCTs each, omalizumab and ustekinumab were comparable with placebo, while antithymic stromal lymphopoietin receptor, infliximab, and rituximab lacked adequate evidence of efficacy. All medications had a comparable safety profile to placebo.

Limitations

Lack of RCTs and the use of variable outcome measures limited conclusions.

Conclusion

Dupilumab is currently the only biologic with robust evidence of efficacy in AD. Nemolizumab, lebrikizumab, and tralokinumab show promise but further data are needed. Longer follow-up and larger studies will establish their safety profile.
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Metadata
Title
Are Biologics Efficacious in Atopic Dermatitis? A Systematic Review and Meta-Analysis
Authors
Igor Snast
Ofer Reiter
Emmilia Hodak
Rivka Friedland
Daniel Mimouni
Yael Anne Leshem
Publication date
01-04-2018
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 2/2018
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.1007/s40257-017-0324-7

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