Systemic treatments in the management of atopic dermatitis: A systematic review and meta-analysis.

Autor: Siegels D; Center for Evidence-Based Healthcare, University Hospital Dresden, Dresden, Germany., Heratizadeh A; Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy Hannover Medical School, Hannover, Germany., Abraham S; Center for Evidence-Based Healthcare, University Hospital Dresden, Dresden, Germany.; Department of Dermatology, Medical Faculty Carl Gustav Carus, University Allergy Center, TU Dresden, Dresden, Germany., Binnmyr J; The Swedish Asthma- and Allergy Association, Stockholm, Sweden.; The Swedish Asthma- and Allergy Research Foundation, Stockholm, Sweden., Brockow K; Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany., Irvine AD; Department of Clinical Medicine, Trinity College Dublin, Ireland.; Dermatology, Children's Health Ireland, National Children's Research Centre, Dublin, Ireland., Halken S; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark., Mortz CG; Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark., Flohr C; Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK., Schmid-Grendelmeier P; Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich.; Christine-Kuehne Center for Allergy Research and Education CK_CARE, Davos, Switzerland., Van der Poel LA; Department of Paediatric Allergy, Guy's and St Thomas' NHS Foundation Trust, UK., Muraro A; Department of Woman and Child Health, Food Allergy Referral Centre, Padua University Hospital, Padua, Italy., Weidinger S; Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany., Werfel T; Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy Hannover Medical School, Hannover, Germany., Schmitt J; Center for Evidence-Based Healthcare, University Hospital Dresden, Dresden, Germany.
Jazyk: angličtina
Zdroj: Allergy [Allergy] 2021 Apr; Vol. 76 (4), pp. 1053-1076. Date of Electronic Publication: 2020 Nov 04.
DOI: 10.1111/all.14631
Abstrakt: Background: As an evidence resource for the currently planned European Academy of Allergy and Clinical Immunology (EAACI) clinical practice guideline "systemic treatment of atopic dermatitis (AD)," we critically appraised evidence on systemic treatments for moderate-to-severe AD.
Methods: We systematically identified randomized controlled trials (RCTs) investigating the safety and efficacy of systemic treatments for AD up to February 2020. Primary efficacy outcomes were clinical signs, AD symptoms and health-related quality of life. Primary safety outcomes included cumulative incidence rates for (serious) adverse events. Trial quality was assessed applying the Cochrane Risk of Bias Tool 2.0. Meta-analyses were conducted where appropriate.
Results: 50 RCTs totalling 6681 patients were included. Trial evidence was identified for apremilast, azathioprine (AZA), baricitinib, ciclosporin A (CSA), corticosteroids, dupilumab, interferon-gamma, intravenous immunoglobulins (IVIG), mepolizumab, methotrexate (MTX), omalizumab, upadacitinib and ustekinumab. Meta-analyses were indicated for the efficacy of baricitinib [EASI75 RD 0.16, 95% CI (0.10;0.23)] and dupilumab [EASI75, RD 0.37, 95% CI (0.32;0.42)] indicating short-term (ie 16-week treatment) superiority over placebo. Furthermore, efficacy analyses of AZA and CSA indicated short-term superiority over placebo; however, nonvalidated scores were used and can therefore not be compared to EASI.
Conclusion: The most robust, replicated high-quality trial evidence is present for the efficacy and safety of dupilumab for up to 1 year in adults. Robust trial evidence was further revealed for AZA, baricitinib and CSA. Methodological restrictions led to limited evidence-based conclusions for all other systemic treatments. Head-to-head trials with novel systemic treatments are required to clarify the future role of conventional therapies.
(© 2020 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: