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.