Upadacitinib and Dupilumab Demonstrate Superior Efficacy in the
Treatment of Adolescent Atopic Dermatitis: A Network Meta-Analysis
Abstract
Objective: This systematic review and network meta-analysis
aimed to compare and evaluate the efficacy and safety of five
medications, Dupilumab, Tralokinumab, Upadacitinib, Baricitinib, and
Abrocitinib, for the treatment of adolescent atopic dermatitis, in order
to provide decision support to support clinical decision-making by
developing more scientifically-grounded and effective treatment
strategies. Methods: A comprehensive search was conducted in
PubMed, Embase, Web of Science (WoS), and the Cochrane database to
collect randomized controlled trials (RCTs) and Phase 3 clinical trials
up to April 13, 2024. Supplementary data were retrieved from trial
registries, and researchers contacted study authors and pharmaceutical
companies when necessary to obtain complete data. Inclusion criteria
comprised treatment studies for moderate to severe atopic dermatitis in
adolescents aged 12 and above, with outcome measures including efficacy
and safety assessments. Data extraction and risk bias assessment were
independently performed by two researchers, using Excel for data
extraction and the netmeta package in R software for network
meta-analysis. Sensitivity analysis and bias risk assessment were
conducted to validate the robustness and credibility of the results. Our
research protocol was registered in PROSPERO (CRD42023480597) and did
not require approval from an institutional review board or written
informed consent. Results: In the primary efficacy outcome
measures, Upadacitinib 30mg/d, Upadacitinib 15mg/d, and Dupilumab
300mg/2w demonstrated excellent efficacy in EASI75 compared to placebo,
significantly outperforming other medications and placebo. Dupilumab 300
mg/2w, Upadacitinib 30 mg/d, and Upadacitinib 15mg/d showed excellent
treatment effects in IGA0/1. Among the outcome measures for improvement
in itch severity rating PP-NRS4, Dupilumab 300mg/2w and Tralokinumab
300mg/2w showed the highest efficacy values. Compared to these
medications, Baricitinib 1mg/d exhibited weaker performance across all
three indicators, particularly in EASI75 and IGA0/1, with effects
approaching no significant difference. Due to limited sample sizes,
estimates for treatment-emergent adverse events (TEAEs), serious adverse
events (SAEs), and drug-induced adverse events (DIAEs) safety indicators
were unstable, preventing strong conclusions on safety outcomes. Further
studies with long-term follow-up and larger sample sizes are required to
explore the safety of these five medications in the adolescent
population. Conclusion: Upadacitinib and Dupilumab demonstrate
strong efficacy and symptom improvement in the treatment of moderate to
severe atopic dermatitis in adolescents, particularly in reducing the
severity of skin lesions and itchiness. Therefore, these medications
should be considered as primary treatment options for adolescents with
atopic dermatitis.