Researchers analyzed existing local and systemic treatments for eczema and identified the most effective treatments. They say their findings offer a full range of treatment options that could inform optimal management of this common chronic skin disease.
Atopic dermatitis (AD), commonly known as eczema, is the most common chronic inflammatory skin disease, affecting 15% to 20% of children and 3% to 10% of adults worldwide. Often a lifelong condition, skin inflammation and itching are hallmarks of the disease, which can interfere with sleep and impair quality of life.
Eczema treatments fall into two categories: prescription topical medications (such as creams and ointments) and "systemic" or systemic treatments used when topical medications don't relieve symptoms. Systemic treatments include immunosuppressants, monoclonal antibodies, and immune system modulators.
To inform and optimize eczema treatment, researchers at McMaster University in Canada published two studies assessing the effectiveness of topical and systemic eczema treatments, looking at factors such as disease activity, sleep disturbance, itch severity, quality of life and adverse events.
In the first study, researchers reviewed 219 randomized controlled trials (43,123 participants in total) of topical treatments for mild to moderate eczema and performed a meta-analysis. Comparing the effects of 68 treatments with a control group, they found that some treatments were significantly better than others.
Pimecrolimus (ElidelCream), tacrolimus (Protopic), and moderate-potency topical corticosteroids (such as prednicate, methylprednisolone, and triamcinolone) are the most effective drugs in reducing eczema severity, pruritus severity, and sleep disturbance. There is little difference in the effectiveness of once-daily versus twice-daily topical treatments. Topical antibiotics are least effective when used alone or in combination with other topical treatments.
As in the first study, in the second study, researchers examined the effectiveness of systemic eczema treatments. They looked at 149 randomized trials involving 28,686 participants, comparing 75 treatments for moderate to severe disease. They found that high-dose upadatinib (Rinvoq) was one of the most effective treatments, but also one of the most harmful in terms of adverse events. Upadacitinib is a Janus kinase (JAK) inhibitor that reduces inflammation by reducing the activity of the immune system (immunosuppressant). Dupilumab (Dupixent), lebrikizumab, and tralokinumab (Adtralza, Adbry) have moderate efficacy and are among the safest treatments. All three are human monoclonal antibody treatments.
The researchers hope their findings will expand treatment options for people with eczema and inform their caregivers and clinicians.
"Given that AD is the most common chronic inflammatory skin disease worldwide, our findings have important and direct implications for achieving optimal outcomes in AD," the researchers said.
Both studies were published in the Journal of Allergy and Clinical Immunology.