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Efficacy and safety of dupilumab for moderate-to-severe atopic dermatitis: a systematic review for the EAACI Biologicals Guidelines
  • +23
  • Ioana Agache,
  • Yang Song,
  • Margarita Posso,
  • Pablo Alonso-Coello,
  • Claudio Rocha,
  • Ivan Sola,
  • Jessica Beltran,
  • Cezmi Akdis,
  • Mubeccel Akdis,
  • Knut Brockow,
  • T. Chivato,
  • Stefano R. Del Giacco,
  • Thomas Eiwegger,
  • Kilian Eyerich,
  • Ana Giménez Arnau,
  • Jan Gutermuth,
  • Emma Guttmann-Yassky,
  • Marcus MaurerOrcid,
  • Graham Ogg,
  • Peck Ong,
  • Liam O'Mahony,
  • Jürgen Schwarze,
  • Thomas Werfel,
  • Carlos Canelo-Aybar,
  • Oscar Palomares,
  • Marek Jutel
Ioana Agache
Transylvania University of Brasov
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Yang Song
Biomedical Research Institute Sant Pau
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Margarita Posso
IMIM
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Pablo Alonso-Coello
Hospital Sant Pau
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Claudio Rocha
Biomedical Research Institute Sant Pau
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Ivan Sola
Biomedical Research Institute
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Jessica Beltran
Biomedical Research Institute Sant Pau
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Cezmi Akdis
University of Zurich
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Mubeccel Akdis
University of Zürich
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Knut Brockow
Technical University of Munich
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T. Chivato
Univ CEU San Pablo
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Stefano R. Del Giacco
University of Cagliari Faculty of Medicine
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Thomas Eiwegger
The Hospital for Sick Children
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Kilian Eyerich
TUM
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Ana Giménez Arnau
Hospital del Mar. Institut Mar d´Investigacions Mediques
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Jan Gutermuth
Universitair Ziekenhuis Brussel
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Emma Guttmann-Yassky
Rockefeller University
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Marcus Maurer
Orcid
Charité Universitätsmedizin Berlin
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Graham Ogg
University of Oxford
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Peck Ong
Childrens Hospital Los Angeles, University of Southern California Keck School of Medicine
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Liam O'Mahony
University College Cork National University of Ireland
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Jürgen Schwarze
University of Edinburgh, Edinburgh
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Thomas Werfel
Hannover Medical School
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Carlos Canelo-Aybar
Biomedical Research Institute Sant Pau
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Oscar Palomares
Complutense University of Madrid
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Marek Jutel
Wroclaw Medical University
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Peer review status:Published

08 Jul 2020Submitted to Allergy
08 Jul 2020Assigned to Editor
08 Jul 2020Submission Checks Completed
08 Jul 2020Reviewer(s) Assigned
13 Jul 2020Review(s) Completed, Editorial Evaluation Pending
14 Jul 2020Editorial Decision: Accept
21 Jul 2020Published in Allergy. 10.1111/all.14510

Abstract

This systematic review evaluates the efficacy, safety and economic impact of dupilumabcompared to standard of care for uncontrolled moderate-to-severe atopic dermatitis (AD). Pubmed, EMBASE and Cochrane Library were searched for RCTs and health economic evaluations. Critical and important AD-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Seven RCTs including 1845 subjects > 12 years treated with dupilumab16 to 52 weeks were evaluated. For adultsthere is high certainty that dupilumabdecreasesSCORAD (MD -30,72; 95%CI -34,65% to -26,79%) and EASI-75 (RR 3.09; 95%CI 2.45 to 3.89), pruritus (RR 2.96; 95%CI 2.37 to 3.70), rescue medication (RR 3.46; 95%CI 2.79 to 4.30), sleep disturbance (MD -7.29; 95%CI -8.23 to -6.35), anxiety/depression (MD -3.08; 95% CI -4.41 to -1.75) and improves quality of life (MD -4.80; 95% CI -5.55 to -4.06). The efficacy for adolescents is similar. Dupilumab-related adverse events (AEs) slightly increase (low certainty). The evidence for dupilumab-related serious AE is uncertain. The incremental cost-effectiveness ratio ranged from 28,500 £ (low certainty) to 124,541 US$ (moderate certainty).More data on long term safety are needed both for children and adults, together with more efficacy data in the paediatric population.