OBJECTIVES: To compare efficacy and safety measures in clinical trials of biologic interventions in adolescents with moderate-to-severe atopic dermatitis.

METHODS: MEDLINE, Embase, and trial registries were searched for studies published between 1 Jan 2013 to 30 Sep 2023, and conference proceedings between 2020 and 2023. Double-blind, randomized placebo-controlled clinical trials assessing the efficacy of biologic therapies on the proportion of adolescents with moderate-to-severe atopic dermatitis were included after screening. Data were extracted from reports in duplicate. Bayesian network meta-analyses were performed and certainty of evidence assessed through Confidence in Network Meta-Analysis.

RESULTS: Primary outcomes included proportion of participants who achieved 75% improvement in Eczema Area and Severity Index score (EASI-75) and the proportion of participants who achieved 0 (clear) or 1 (almost clear) value on Investigators’ Global Assessment (IGA 0/1) (score range 0-4) at week 16. Secondary outcomes included the proportion of participants who achieved a peak pruritus Numeric Rating Scale score improvement of 4 points or greater (score range 0-10), as well as a mean change in Children’s Dermatology Life Quality Index (score range 0-30) at week 16 from baseline. Four trials evaluating three drugs, dupilumab, lebrikizumab, and tralokinumab, representing 642 study participants were analyzed. Two dosing options were assessed for dupilumab and tralokinumab. Compared to placebo, the greatest effect was observed with dupilumab 200 or 300 mg every 2 weeks in both EASI-75 (risk ratio [RR] 5.2; 95% credible interval [CrI]: 2.6, 12.0) and IGA 0/1 (RR 12.0; 95% CrI: 3.3, 78.0). The certainty of our generated evidence was determined to be very low across all assessed outcomes.

CONCLUSIONS: Our findings suggest that dupilumab is the most efficacious biological treatment for AD in adolescents in achieving EASI-75 and IGA Score 0/1 in the short-term. Future studies, ideally a head-to-head trial, are needed to further confirm these results.