Abstract
Given the lack of head-to-head studies of novel non-steroidal molecule topical therapies in mild-to-moderate atopic dermatitis (AD), network meta-analyses (NMAs) can provide comparative efficacy and safety data for clinical decision-making. In this NMA, we performed a literature search until 01 March 2023 for eligible studies written in English using databases, including PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov. Only double-blind randomized clinical trials (RCTs) with topical Ruxolitinib, Crisaborole, or Tapinarof versus vehicle for patients with mild-to-moderate AD were included. Baseline and follow-up data were extracted. Efficacy was evaluated using Investigator’s Global Assessment (IGA) achieving “clear” or “almost clear,” with 2 points or more improvement from baseline at the end of treatment, referred to as “IGA success.” For binary outcomes, we analyzed in random-effects Bayesian NMA consistency models to compare the efficacy of these 3 topical therapies by odds ratio (OR) with 95% credibility interval (CrI). Overall, 10 phase 2 or phase 3 RCTs were identified, which included 4010 patients with mild to moderate AD. Compared with the topical vehicle control, all these 3 treatments had higher response rate of “IGA success” at the end of trial (Ruxolitinib 1.5% b.i.d: OR, 11.94; 95%CrI, 6.28–23.15; Crisaborole 2% b.i.d: OR, 2.08; 95%CrI, 1.46–3.52; Tapinarof 1% b.i.d: OR, 2.64; 95%CrI, 0.75–9.70). Notably, Ruxolitinib 1.5% b.i.d. had the highest probability of achieving “IGA success” in ranking analysis (Rank 1, SUCRA = 0.75) and lower risk of AE (Rank 8, SUCRA = 0.22). Besides, there was no difference in treatment-related adverse events between 3 therapies. Heterogeneity was not significant across studies.
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The data that support the findings of this study are available from the corresponding author upon reasonable request.
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This study was supported by the National Natural Science Foundation of China (NSFC 8227120662).
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The titles and abstracts will be screened by two independent reviewers (JW.L and YF.F) for potential eligibility. Full text articles will be assessed for eligibility by two authors (XC.C and LB.S). XC.C wrote the main manuscript text and prepared figures. An expert (Y.L) was available to provide advice if there was any disagreement. All authors reviewed the manuscript. The authors confirm that no paper mill and artificial intelligence was used.
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Cao, Xc., Lu, Jw., Feng, Yf. et al. Efficacy and safety of Ruxolitinib, Crisaborole, and Tapinarof for mild-to-moderate atopic dermatitis: a Bayesian network analysis of RCTs. Naunyn-Schmiedeberg's Arch Pharmacol (2024). https://doi.org/10.1007/s00210-024-02971-6
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DOI: https://doi.org/10.1007/s00210-024-02971-6