Efficacy and safety of dupilumab for moderate-to-severe atopic dermatitis: A systematic review for the EAACI biologicals guidelines.

Abstract

This systematic review evaluates the efficacy, safety and economic impact of dupilumab compared to standard of care for uncontrolled moderate-to-severe atopic dermatitis (AD). Pubmed, EMBASE and Cochrane Library were searched for RCTs and health economic evaluations. Critical and important AD-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Seven RCTs including 1845 subjects >12 years treated with dupilumab 16 to 52 weeks were evaluated. For adults, there is high certainty that dupilumab decreases SCORAD (MD -30,72; 95% CI -34,65% to -26,79%) and EASI-75 (RR 3.09; 95% CI 2.45 to 3.89), pruritus (RR 2.96; 95% CI 2.37 to 3.70), rescue medication (RR 3.46; 95% CI 2.79 to 4.30), sleep disturbance (MD -7.29; 95% CI -8.23 to -6.35) and anxiety/depression (MD -3.08; 95% CI -4.41 to -1.75) and improves quality of life (MD -4.80; 95% CI -5.55 to -4.06). The efficacy for adolescents is similar. Dupilumab-related adverse events (AEs) slightly increase (low certainty). The evidence for dupilumab-related serious AE is uncertain. The incremental cost-effectiveness ratio ranged from 28 500 £ (low certainty) to 124 541 US$ (moderate certainty). More data on long-term safety are needed both for children and for adults, together with more efficacy data in the paediatric population. Registration: PROSPERO (CRD42020153645).

• Authors: Ioana Agache, Yang Song, Margarita Posso, Pablo Alonso-Coello, Claudio Rocha, Ivan Solà, Jessica Beltran, Cezmi A Akdis, Mubeccel Akdis, Knut Brockow, Tomas Chivato, Stefano Del Giacco, Thomas Eiwegger, Kilian Eyerich, Ana Giménez-Arnau, Jan Gutermuth, Emma Guttman-Yassky, Marcus Maurer, Graham Ogg, Peck Y Ong, Liam O'Mahony, Jürgen Schwarze, Thomas Werfel, Carlos Canelo-Aybar, Oscar Palomares, Marek Jutel
• Journal: Allergy (Allergy) Vol. 76 Issue 1 Pg. 45-58 (01 2021) ISSN: 1398-9995 [Electronic] Denmark
• PMID: 32691892 (Publication Type: Journal Article, Systematic Review)
• Copyright: © 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Chemical References

• Antibodies, Monoclonal, Humanized
• Biological Products
• dupilumab

Topics

• Adolescent
• Adult
• Antibodies, Monoclonal, Humanized
• Biological Products
• Child
• Dermatitis, Atopic (drug therapy)
• Humans
• Quality of Life