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Studies examine optimal topical, systemic Txs for AD

Photo by: James Heilman, MD, via Wikimedia Commons

Two reviews from researchers at McMaster University in Hamilton have identified the most effective topical and systemic treatments for atopic dermatitis (AD).

The goals of the studies were to evaluate all treatment options for AD, and to optimize disease management among patients, caregivers, and clinicians, the researchers noted.

Both papers were published in The Journal of Allergy and Clinical Immunology.

The study assessing topical treatments included 219 trials of AD topical treatments identified through MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT searches to Sept. 5, 2022. The number of patients totalled 43,123, with 68 topical interventions.

Led by Dr. Derek Cho, assistant professor in the Department of Medicine at McMaster, the researchers assessed patient-important outcomes such as AD severity, itch, sleep, AD-quality of life, flares, and potential harms.

In the topical study, the researchers determined the topical calcineurin inhibitors pimecrolimus and tacrolimus, and moderate-potency topical corticosteroids were among the most effective in improving and maintaining outcomes. They report that topical antibiotics alone or in combination may be among the least effective.

The same group of researchers also evaluated systemic treatments for AD in another study using the same literature review approach (but up to Nov. 29, 2022) for randomized trials addressing systemic treatments and phototherapy for AD. In this search, they identified 149 randomized controlled trials involving 28,686 participants and 75 systemic treatments.

They determined that among individuals with moderate-to-severe AD, high-dose upadacitinib was among the most effective in addressing multiple patient-important outcomes, but also had the most side effects. High-dose abrocitinib and low-dose upadacitinib were also effective but can produce side effects. Dupilumab, lebrikizumab, and tralokinumab have intermediate effectiveness and a favourable safety profile, the researchers reported.


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