Efficacy and safety of dupilumab for moderate-to-severe atopic
dermatitis: a systematic review for the EAACI Biologicals Guidelines
This systematic review evaluates the efficacy, safety and economic
impact of dupilumabcompared 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 dupilumab16
to 52 weeks were evaluated. For adultsthere is high certainty that
dupilumabdecreasesSCORAD (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), 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 adults, together with more
efficacy data in the paediatric population.