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Systemic treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials.
Chu, Alexandro W L; Wong, Melanie M; Rayner, Daniel G; Guyatt, Gordon H; Díaz Martinez, Juan Pablo; Ceccacci, Renata; Zhao, Irene X; McMullen, Eric; Srivastava, Archita; Wang, Jason; Wen, Aaron; Wang, Fang Chi; Brignardello-Petersen, Romina; Izcovich, Ariel; Oykhman, Paul; Wheeler, Kathryn E; Wang, Julie; Spergel, Jonathan M; Singh, Jasvinder A; Silverberg, Jonathan I; Ong, Peck Y; O'Brien, Monica; Martin, Stephen A; Lio, Peter A; Lind, Mary Laura; LeBovidge, Jennifer; Kim, Elaine; Huynh, Joey; Greenhawt, Matthew; Gardner, Donna D; Frazier, Winfred T; Ellison, Kathy; Chen, Lina; Capozza, Korey; De Benedetto, Anna; Boguniewicz, Mark; Smith Begolka, Wendy; Asiniwasis, Rachel N; Schneider, Lynda C; Chu, Derek K.
Afiliação
  • Chu AWL; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Wong MM; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Rayner DG; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Guyatt GH; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Díaz Martinez JP; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Ceccacci R; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Zhao IX; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • McMullen E; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Srivastava A; Evidence in Allergy Group, McMaster University, Hamilton, Canada; Department of Internal Medicine, Western University, London, Canada.
  • Wang J; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Wen A; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Wang FC; Evidence in Allergy Group, McMaster University, Hamilton, Canada; Schulich School of Medicine & Dentistry, Western University, London, Canada.
  • Brignardello-Petersen R; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Izcovich A; Servicio de Clínica Médica, Hospital Aleman, Buenos Aires, Argentina.
  • Oykhman P; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Wheeler KE; Department of Pediatrics, University of Florida, Gainesville, Fla.
  • Wang J; Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Spergel JM; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Singh JA; Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala.
  • Silverberg JI; Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
  • Ong PY; Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, Calif.
  • O'Brien M; Tufts University School of Medicine, Boston, Mass.
  • Martin SA; UMass Chan Medical School, Worcester, Mass.
  • Lio PA; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
  • Lind ML; School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Ariz.
  • LeBovidge J; Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
  • Kim E; Toronto, Canada.
  • Huynh J; Sepulveda VA Medical Center, North Hills, Calif.
  • Greenhawt M; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colo.
  • Gardner DD; Allergy & Asthma Network, Fairfax, Va.
  • Frazier WT; Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pa.
  • Ellison K; Westerville, Ohio.
  • Chen L; Evidence in Allergy Group, McMaster University, Hamilton, Canada; Department of Pediatrics, McMaster University, Hamilton, Canada.
  • Capozza K; Global Parents for Eczema Research, Santa Barbara, Calif.
  • De Benedetto A; Department of Dermatology, University of Rochester Medical Center, Rochester, NY.
  • Boguniewicz M; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colo.
  • Smith Begolka W; National Eczema Association, Novato, Calif.
  • Asiniwasis RN; Department of Dermatology, University of Saskatchewan, Regina, Saskatchewan, Canada.
  • Schneider LC; Division of Immunology, Boston Children's Hospital, Boston, Mass.
  • Chu DK; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Canada. Electro
J Allergy Clin Immunol ; 152(6): 1470-1492, 2023 12.
Article em En | MEDLINE | ID: mdl-37678577
ABSTRACT

BACKGROUND:

Atopic dermatitis (AD) is an inflammatory skin condition with multiple systemic treatments and uncertainty regarding their comparative impact on AD outcomes.

OBJECTIVE:

We sought to systematically synthesize the benefits and harms of AD systemic treatments.

METHODS:

For the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, Web of Science, and GREAT databases from inception to November 29, 2022, for randomized trials addressing systemic treatments and phototherapy for AD. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-related quality of life, flares, and harms. The Grading of Recommendations Assessment, Development and Evaluation approach informed certainty of evidence ratings. This review is registered in the Open Science Framework (https//osf.io/e5sna).

RESULTS:

The 149 included trials (28,686 patients with moderate-to-severe AD) evaluated 75 interventions. With high-certainty evidence, high-dose upadacitinib was among the most effective for 5 of 6 patient-important outcomes; high-dose abrocitinib and low-dose upadacitinib were among the most effective for 2 outcomes. These Janus kinase inhibitors were among the most harmful in increasing adverse events. With high-certainty evidence, dupilumab, lebrikizumab, and tralokinumab were of intermediate effectiveness and among the safest, modestly increasing conjunctivitis. Low-dose baricitinib was among the least effective. Efficacy and safety of azathioprine, oral corticosteroids, cyclosporine, methotrexate, mycophenolate, phototherapy, and many novel agents are less certain.

CONCLUSIONS:

Among individuals with moderate-to-severe AD, high-certainty evidence demonstrates that high-dose upadacitinib is among the most effective in addressing multiple patient-important outcomes, but also is among the most harmful. High-dose abrocitinib and low-dose upadacitinib are effective, but also among the most harmful. Dupilumab, lebrikizumab, and tralokinumab are of intermediate effectiveness and have favorable safety.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Asma / Dermatite Atópica / Eczema Idioma: En Ano de publicação: 2023 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Asma / Dermatite Atópica / Eczema Idioma: En Ano de publicação: 2023 Tipo de documento: Article