EMA-approved biologics and JAK inhibitors show meaningful short-term EASI-75 responses in moderate-to-severe atopic dermatitisNewer Eczema Drugs Clear Skin for Many, But Comparisons Are Tricky

Frontiers in Medicine Published October 31, 2026 DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Interpret cross-trial EASI-75 rates cautiously; no head-to-head or pooled comparative data exist.

This systematic review examined randomized controlled trials of EMA-approved systemic therapies for adults with moderate-to-severe atopic dermatitis, covering the biologics dupilumab, tralokinumab, lebrikizumab, and nemolizumab, and the JAK inhibitors upadacitinib, abrocitinib, and baricitinib at recommended adult doses. The primary outcome of interest was the proportion of patients achieving EASI-75 at the primary trial endpoint, generally in the range of 12 to 16 weeks. Comparators were placebo, and no head-to-head trials were identified.

Across the included trials, EASI-75 response rates varied considerably by agent, and upadacitinib showed the highest observed response rate in the review. Placebo EASI-75 responses were also substantial and were consistently higher in combination-therapy trials. Nemolizumab data were limited to combination-therapy settings. Adverse events were common across therapies, while serious adverse events were generally low.

The authors emphasize substantial clinical and methodological heterogeneity, including differences in trial design, outcome reporting, and follow-up duration, which precluded meta-analysis. No pooled effect sizes or confidence intervals were calculated, and the synthesis is descriptive. The absence of long-term comparative data and of head-to-head trials further limits interpretation.

Clinically, these findings support the short-term efficacy and acceptable safety of EMA-approved systemic therapies for moderate-to-severe atopic dermatitis, while reinforcing that treatment selection should remain individualized. Cross-trial response rates should not be read as evidence of comparative efficacy between agents.

If you have moderate-to-severe eczema, you know the itch that won't quit and the patches that won't fade. A new review of 25 randomized trials looks at seven newer systemic treatments for atopic dermatitis, the most common form of eczema, in adults. These are biologics (dupilumab, tralokinumab, lebrikizumab, nemolizumab) and JAK inhibitors (upadacitinib, abrocitinib, baricitinib).

The main measure was EASI-75: at least a 75% drop in eczema severity at 12 to 16 weeks. Response rates ranged widely. Dupilumab hit 44% to 69%. Lebrikizumab reached 60.6%. Tralokinumab ranged from 25% to 64%. Nemolizumab reached 49.1%, but only in combination-therapy trials. Upadacitinib showed the highest observed rate at 73.0% at 16 weeks. Abrocitinib reached 64.6% at 12 weeks. Baricitinib ranged from 17.9% to 48.0%. Placebo responses ranged from 6% to 36% and ran higher in combination-therapy trials.

Side effects were common but serious events were generally low across therapies. Any adverse event ranged from 45.2% (abrocitinib 100 mg) to 82.46% (nemolizumab).

Here's the catch: the trials differed so much in design, outcome reporting, and follow-up that the researchers couldn't pool the numbers. No head-to-head trials were found, and there's no long-term comparative data. So don't read these percentages as a ranking. Upadacitinib's 73.0% is the highest observed rate across very different trials, not proof it beats the others. Treatment choice should stay individual, and that's a conversation for you and your doctor.

What this means for you:

Seven eczema drugs helped many adults in trials, but differing study designs mean no clear winner.

Common questions

Which eczema drug works best?

The review can't say. Trials differed too much in design and reporting to compare drugs fairly, and no head-to-head trials were found. Upadacitinib showed the highest observed response rate at 73.0% at 16 weeks, but that's across very different trials, not proof it beats the others. Ask your doctor which option fits you.

What does EASI-75 mean?

EASI-75 means a patient's eczema severity score dropped by at least 75% from where they started. It's a common way trials measure success. In this review, response rates at 12 to 16 weeks ranged from 17.9% to 73.0% across the seven drugs, with placebo responses from 6% to 36%.

What are the side effects of these eczema treatments?

Any adverse event occurred in 45.2% (abrocitinib 100 mg) to 82.46% (nemolizumab) of patients. Serious adverse events were generally low across therapies, though specific rates weren't reported. The review didn't report discontinuation or tolerability details. Talk with your doctor about what side effects to watch for.

Were these drugs tested against each other?

No. The review found no head-to-head trials. Each drug was compared with placebo, and placebo response rates ranged from 6% to 36%, running higher in combination-therapy trials. Without direct comparisons, you can't rank the drugs by these numbers. Long-term comparative data are also missing.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedOct 2026

View Original Abstract ↓

BackgroundAtopic dermatitis (AD) is a common, chronic inflammatory skin condition, and patients with moderate-to-severe disease often require systemic therapy. Since 2017, targeted systemic agents, biologics and Janus kinase (JAK) inhibitors, have expanded treatment options available, but comparative evidence remains limited by heterogeneous trial design, outcome reporting, and follow-up duration.ObjectiveTo systematically review the efficacy and safety of European Medicines Agency (EMA)-approved systemic therapies for moderate-to-severe AD in adults.MethodsFollowing PRISMA 2020 guidelines, we searched PubMed/MEDLINE, Embase and Web of Science for randomized controlled trials evaluating EMA-approved biologics (dupilumab, tralokinumab, lebrikizumab, nemolizumab) and JAK inhibitors (upadacitinib, abrocitinib, baricitinib) at recommended adult doses. The primary outcome was the proportion of patients achieving EASI-75 at the primary trial endpoint (12–16 weeks). Due to substantial clinical and methodological heterogeneity, a structured narrative synthesis was conducted rather than a meta-analysis.ResultsTwenty-five RCTs met inclusion criteria. At EMA-recommended doses, EASI-75 responses ranged from 44% to 69% for dupilumab, 60.6% for lebrikizumab, 25-64% for tralokinumab, and 49.1% for nemolizumab (combination-therapy data only). Among JAK inhibitors, upadacitinib showed the highest observed response rate (73.0% at 16 weeks), followed by abrocitinib (64.6% at 12 weeks) and baricitinib (17.9-48.0%). Placebo response rates ranged from 6% to 36% and were consistently higher in combination-therapy trials. Any adverse event occurred in 45.2% (abrocitinib 100 mg) to 82.46% (nemolizumab) of patients, with serious adverse events generally low across therapies.ConclusionEMA-approved systemic therapies for moderate-to-severe AD demonstrate meaningful short-term efficacy and acceptable safety. However, treatment selection should remain individualized given cross-trial heterogeneity and the current absence of long-term comparative data. Further head-to-head trials and real-world evidence are needed to optimize treatment sequencing.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420251102911

EMA-approved biologics and JAK inhibitors show meaningful short-term EASI-75 responses in moderate-to-severe atopic dermatitisNewer Eczema Drugs Clear Skin for Many, But Comparisons Are Tricky

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EMA-approved biologics and JAK inhibitors show meaningful short-term EASI-75 responses in moderate-to-severe atopic dermatitisNewer Eczema Drugs Clear Skin for Many, But Comparisons Are Tricky

Common questions

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