Dupilumab Superior in Analysis of Monoclonal Antibodies for Atopic Dermatitis

Several monoclonal antibodies significantly outperformed placebo for key atopic dermatitis endpoints, new systematic review data suggest, with dupilumab having the strongest overall efficacy and safety profile.1

These data also suggest spesolimab and rademikibart led individual Eczema Area and Severity Index (EASI) score response rankings. The findings resulted from a systematic review and meta-analysis authored by investigators such as Jinping Zhang, MD, of Nanjing Drum Tower Hospital.

Zhang et al noted set out to compare safety and efficacy findings on monoclonal antibodies for the treatment of moderate-to-severe atopic dermatitis. They highlighted the growing necessity of evaluating monoclonal antibodies relative impacts, noting the consequent value of network meta-analyses (NMA).2

“This systematic review and NMA aim to comprehensively assess all mAb used in moderate-to-severe AD, ranking their therapeutic and safety profiles to inform clinical decision-making,” Zhang and coauthors wrote.1

Comparisons of Monoclonal Antibodies

From the time of database inception to November 2024, the investigative team carried out a comprehensive search of the Embase, PubMed, Web of Science, and Cochrane Library databases. They incorporated the terms "Atopic Dermatitis," “Amlitelimab,” “Astegolimab,” “CM310,” “Dupilumab,” “Eblasakimab,” “Fezakinumab,” "Nemolizumab," “Lebrikizumab,” “Rademikibart,” “Spesolimab,” “Tralokinumab,” “Ustekinumab,” and “Randomized controlled trial" into their searches.

References identified within the records the team assessed were also reviewed by Zhang and colleagues to ensure that no relevant research was overlooked. Randomized controlled trials which were published in English were deemed eligible. Participants included within their assessment had been given monoclonal antibody monotherapy, and any research combining such drugs with corticosteroids were not included.

Placebo served as the comparator across the various trials included in Zhang et al's analysis. Additionally, the investigators did not include studies without detailed information on EASI-50, EASI-75, or EASI-90, or those without a placebo arm, in their consideration. The main endpoints evaluated by the team consisted of EASI-50, EASI-75, EASI-90, and the proportion of included subjects attaining an Investigator’s Global Assessment (IGA) score of 0 or 1.

Among the secondary outcomes evaluated, Zhang et al highlighted percentage changes from the point of baseline in EASI, Pruritus Numerical Rating Scale (NRS), and SCORing Atopic Dermatitis (SCORAD), as well as any shifts in Body Surface Area (BSA) and Dermatology Life Quality Index (DLQI). Safety assessments were focused on any occurrences of adverse events (AEs), serious AEs, and treatment cessation resulting from AEs.

NoteExpress software was implemented by Zhang and colleagues to manage and organize the available research. They had 2 reviewers to carry out the initial screening of all data and align their selection criteria. A third reviewer looked into any articles for which disagreements arose. Data extraction was performed by the investigative team utilizing Excel 2019, with a single researcher entering data and another conducting verification.

There were 607 records assessed by the team, and 253 duplicates were removed. This left 354 unique articles. The screening of titles and abstracts excluded 242 of these studies, and another 80 articles were taken out by the investigators following the performance of their full-text evaluations. The final dataset consisted of 32 eligible studies.

Altogether, there were 32 RCTs involving 7588 subjects were included. Spesolimab, dupilumab, rademikibart, and amlitelimab all showed superior performance compared with placebo for EASI-50 (risk ratios 1.31–22.65), EASI-75 (1.51–36.58), EASI-90 (3.72–5.49), and attaining an IGA score of 0 or 1 (1.78–13.36). Basing their conclusions on SUCRA rankings, Zhang and colleagues found dupilumab performed particularly well across percent reductions in EASI, NRS, and SCORAD.

Overall, treatment with dupilumab was shown by the investigative team to have a significantly lower incidence of serious AEs compared to placebo (RR = 0.43, 95% CI 0.30–0.63). Other safety analyses identified by Zhang and coauthors demonstrated no statistically significant distinctions between treatment and control cohorts in these studies.

“NMA provided effective evidence for evaluating the efficacy and safety of monoclonal antibody in the treatment of AD,” they wrote.1 “From the perspective of SUCRA ranking, Spesolimab may be the best option to improve EASI-50. Rademikibart may be considered more effective than other interventions in improving EASI-75, while Dupilumab may be most beneficial for EASI-90. Dupilumab had better efficacy in improving NRS, EASI and SCORAD scores.”

References

1. W Cai, L Fu, J Zhang. Efficacy and Safety of All Monoclonal Antibodies in Moderate-to-Severe Atopic Dermatitis: A Systematic Review and Network Meta-Analysis. Pharmacoepidemiology and Drug Safety 34, no. 12 (2025): e70268, https://doi.org/10.1002/pds.70268.

2. S Lin, Q Shi, F Yang, et al. Traditional Chinese Medicine Injections for Heart Failure: A Protocol for Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. BMJ Open 10, no. 9 (2020): e37331.