Dupilumab treatment in moderate-to-severe atopic dermatitis: A systematic review and meta-analysis

Background Dupilumab, a fully human monoclonal antibody against the interleukin-4-receptor α subunit, has been developed and used in clinical trials to treat atopic dermatitis (AD). Objective We aimed to assess the overall efficacy and safety of dupilumab treatment in AD. Methods PubMed, Embase, Cochrane library databases, and the Chinese Biological Medicine (CBM) published up to September 2017 were searched. All randomized controlled trials (RCTs) of dupilumab treatment on adult patients with AD were included. Fixed- or random-effects models were used to calculate pooled standard mean differences or relative risks (SMD or RR, respectively). Results Six trials involving 2447 patients were identified. Pooled analysis revealed significant improvements in Eczema Area and Severity Index (EASI) score (SMD = −0.89, 95% CI: −1.0 to −0.78), percentage of body surface area (BSA) (SMD = −0.83, 95% CI: −0.90 to −0.75), pruritus numeric rating scale (NRS) scores (SMD = −0.81, 95% CI: −0.96 to −0.66), and Dermatology Life Quality Index (DLQI) scores (SMD = −0.78, 95% CI: −0.89 to −0.66). Dupilumab treatment was also associated with a significant increase in the proportion of patients achieving Investigator’s Global Assessment (IGA) response (RR = 3.82; 95% CI: 3.23 to 4.51) and a similar incidence of adverse events (RR = 1.0; 95% CI: 0.96 to 1.04). Conclusions Our analysis provided evidence that dupilumab had an acceptable safety profile and resulted in clinically relevant improvements in signs and symptoms of AD. Dose regimens of 300 mg qw and q2 w seemed to have similar benefits. Further long-term trials are required for confirmation.