Biologic Treatments in Adolescents With Moderate-to-Severe Atopic Dermatitis: A Systematic Literature Review and Network Meta-analysis

BACKGROUND: Novel interventions, particularly biologic therapies, have been shown to be efficacious and safe in treating atopic dermatitis (AD) in adolescents. However, the comparative efficacy and safety of biologic interventions in adolescents with moderate-to-severe AD have not been explored. OBJECTIVE: To compare efficacy and safety measures in clinical trials of biologic interventions in adolescents aged 12 to 17 with moderate-to-severe AD. METHODS: MEDLINE, Embase, and trial registries were searched for double-blind, randomized placebo-controlled clinical trials assessing the efficacy of biologic therapies in adolescents with moderate-to-severe AD. Arm-level Bayesian network meta-analyses (NMAs) were performed and certainty of evidence was assessed through the Confidence in Network Meta-Analysis grading tool. Primary outcomes included the proportion of participants who achieved 75% improvement in Eczema Area and Severity Index score (EASI-75) and the proportion of participants who achieved 0 (clear) or 1 (almost clear) value on the Investigators' Global Assessment (IGA 0/1) at week 16. RESULTS: Four trials evaluating 3 drugs, dupilumab, lebrikizumab, and tralokinumab, representing 642 study participants were analyzed. Two dosing options were assessed for dupilumab and tralokinumab. Compared with placebo, the greatest effect was observed with dupilumab 200/300 mg every 2 weeks in both EASI-75 (risk ratio [RR]: 5.2; 95% credible interval [CrI]: 2.6, 12.0) and IGA 0/1 (RR: 12.0; 95% CrI: 3.3, 78.0). No differences were found between treatments. Certainty of the evidence was low. CONCLUSION AND RELEVANCE: Although there is some evidence that dupilumab may be more efficacious than lebrikizumab or tralokinumab, our findings suggest that there is no strong evidence of superiority of one treatment over another.