Efficacy and safety of dupilumab in the treatment of moderate-to-severe atopic dermatitis: a meta-analysis of randomized controlled trials

Introduction
Patients with atopic dermatitis (AD) have high disease burden negatively affecting quality of life. Aim: To assess the efficacy and safety of dupilumab in patients with moderate-to-severe AD.

Material and methods
A systematic literature search was performed using the main-stream databases of PubMed, Web of Science, and Embase. Standard mean difference (SMD) or risk ratios (RR) with 95% confidence interval (95% CI) were calculated using a fixed-effects or random-effects model.

Results
A total of 11 studies with 4094 patients met the inclusion criteria and were included in this meta-analysis. Pooled estimate showed that dupilumab significantly improved the mean change in the Eczema Area and Severity Index (EASI) score (SMD = –10.90, 95% CI: –12.13, –9.68; p < 0.001), percentage of body surface area (BSA) affected (SMD = –10.87, 95% CI: –13.04, –8.70; p < 0.001), pruritus numeric rating scale (NRS) scores (SMD = –9.29, 95% CI: –10.34, –8.25; p < 0.001), and Dermatology Life Quality Index (DLQI) scores (SMD = –9.66, 95% CI: –11.50, –7.82; p < 0.001). In addition, dupilumab was associated with a significantly higher Investigator’s Global Assessment (IGA) response (RR = 3.57, 95% CI: 2.53, 5.03; p < 0.001). The overall incidence of adverse events was comparable between dupilumab and other treatments (RR = 1.00, 95% CI: 0.96, 1.03; p = 0.832). However, the injection-site reaction, headache and conjunctivitis were more frequently seen in patients treated with dupilumab.

Conclusions
Dupilumab is well tolerated, and could improve signs and symptoms of AD. However, the results should be interpreted cautiously since there was significant heterogeneity among the studies.