Helping atopic dermatitis patients find right treatment

King’s College London

Atopic dermatitis, or eczema, affects around 20% of children and 10% of adults and can have a profound impact on patients’ quality of life. A chronic inflammatory disease characterised by itchy, dry and cracked skin, severe atopic dermatitis impairs sleep and often leads to depression, social withdrawal and anxiety.

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Researchers from King’s and Women’s College Hospital, Canada, with support from the NIHR Guy’s and St Thomas’ Biomedical Research Centre, have been working on a living network meta-analysis of systemic immuno-modulatory treatments for atopic dermatitis.

Their most recent update is published today in JAMA Dermatology [hyperlink to paper] and reviews 60 trials involving over 16,000 patients. Immuno-modulatory treatments used for atopic dermatitis include cyclosporine, methotrexate, azathioprine, mycophenolate and dupilumab, with abrocitinib, baricitinib, tralokinumab and upadacitinib recently approved in various countries.

The good news is that we now have many new treatments available, providing greater choice to both patients and clinicians,” explained Dr. Aaron Drucker, dermatologist and scientist at Women’s College Hospital in Toronto, Canada. “In the last year alone, three oral and one injectable medication have come to market. However, the flip side to additional choice is that treatment decisions become more complex.”

To address this issue Dr. Drucker in collaboration with Professor Carsten Flohr, Chair in Dermatology and Population Health Science at St John’s Institute of Dermatology at King’s, are leading a living network meta-analysis of systemic immuno-modulatory treatments for eczema.

A previous study from the group found dupilumab, a biologic treatment, and cyclosporine, an oral immuno-suppressive medication, have greater efficacy than other conventional systemic therapies. The current update found treatment with two Janus kinase inhibitors (abrocitinib 200mg daily and upadacitinib 30mg daily) was somewhat more effective in treating atopic dermatitis than dupilumab.

The study also found the Janus kinase inhibitor baricitinib and the biologic tralokinumab were effective treatments for adults with moderate-to-severe atopic dermatitis.

The majority of trials compare the atopic dermatitis treatment to a placebo, not directly head-to-head against other treatments, and this makes it difficult for clinicians and patients to understand their comparative efficacy. The methodology of a network meta-analysis allows us to compare the different treatments with each other, so that physicians and patients can make more informed treatment choices.– Professor Carsten Flohr, Chair in Dermatology and Population Health Science at St John’s Institute of Dermatology

Recognizing the evolving nature of atopic dermatitis treatments, results from this ongoing collaboration are regularly updated and published on www.eczematherapies.com. On the website patients and clinicians can compare both new and more established medications simultaneously, assessing how they stack up against common areas of concern like disease severity, side effect profiles and impact on quality of life.

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