Network meta-analysis ranks upadacitinib highest for efficacy in moderate-to-severe atopic dermatitis

This network meta-analysis of phase 3 or 4 trials evaluated the relative efficacy of approved systemic targeted therapies in 16,334 adult patients with moderate-to-severe atopic dermatitis. The analysis compared multiple agents, with upadacitinib 30 mg consistently exhibiting the highest probability of achieving each clinical endpoint, including EASI-75, EASI-90, IGA 0/1, and NRS response. Pairwise comparisons showed statistically significant differences among several therapies, while no significant differences were observed between dupilumab 300 mg and stapokibart 300 mg, or between ivarmacitinib 8 mg and upadacitinib 15 mg. Specific effect sizes, absolute numbers, and p-values or confidence intervals for these comparisons were not reported.

Safety and tolerability data, including adverse events, serious adverse events, and discontinuation rates, were not reported in this analysis. The primary limitation is that the findings are derived from indirect comparisons across different trials, rather than direct head-to-head randomized controlled trials. Funding sources and author conflicts of interest were also not reported.

For clinical practice, this analysis provides a hierarchy of efficacy based on available trial data but does not establish definitive superiority. The restrained practice relevance is that these results can inform therapeutic sequencing discussions while acknowledging the evidence is indirect. Head-to-head randomized trials are needed to confirm the relative effectiveness and safety profiles suggested by this network meta-analysis.