What is the best systemic immunosuppressive treatment for eczema?

With a high degree of certainty, network meta‐analysis indicates that when compared with placebo, dupilumab is likely to be the more effective treatment for eczema and is ranked highest among the biological treatments in terms of achieving 75% improvement in Eczema Area and Severity Index scores (EASI75) and improving Patient‐Oriented Eczema Measure (POEM) scores during short‐term follow‐up. Dupilumab was the only immunosuppressive agent for which improvement in POEM in the short term was evaluated. The effect of dupilumab on achieving EASI75 in the long term when compared against placebo was uncertain, as the certainty of this evidence was very low.

This analysis suggests that tralokinumab may be more effective than placebo in achieving EASI75 in the short term. The effect of ustekinumab on achieving EASI75 in the short or long term when compared with placebo was uncertain.

Safety outcomes during long‐term follow‐up were assessed, and there was no statistical difference in the proportions of participants with serious adverse events when any immunosuppressive agent was compared with placebo. There were no differences identified in other adverse events, but dupilumab is associated with specific adverse events, including eye inflammation and eosinophilia.