Dupilumab and Other Monoclonals Rank Highly for Moderate-to-Severe Atopic Dermatitis, Network Meta-Analysis Shows

Primary care physicians may see growing treatment opportunities as a new network meta-analysis finds that all monoclonal antibodies evaluated for moderate-to-severe atopic dermatitis (AD) demonstrated superior efficacy to placebo, with several agents also showing favorable safety profiles.

"The findings provide evidence-based treatment options for clinicians, helping to improve treatment decisions and patient care," researchers wrote in the study published online in the journal Pharmacoepidemiology and Drug Safety.

Data from the systematic review and network meta-analysis of 32 randomized controlled trials (RCTs) including 7588 patients showed that multiple monoclonal antibodies—specifically spesolimab, rademikibart, dupilumab, and amlitelimab—were more effective than placebo across key AD clinical outcomes. Investigators searched PubMed, Embase, Web of Science, and Cochrane Library through November 2024.

Key Efficacy Findings

Across included trials, the following monoclonal antibodies demonstrated superiority to placebo for achieving Eczema Area and Severity Index (EASI) milestones:

• EASI-50: Risk ratios (RRs) ranged from 1.31 to 22.65.
• EASI-75: RRs ranged from 1.51 to 36.58.
• EASI-90: RRs ranged from 3.72 to 5.49.
• Investigator’s Global Assessment (IGA) 0/1: RRs ranged from 1.78 to 13.36.

Dupilumab performed well in surface under the cumulative ranking curve (SUCRA) analyses for percent change in pruritus numerical rating scale (NRS), EASI, and SCORAD scores.

The analysis also evaluated percent change in body surface area, Dermatology Life Quality Index, and other continuous endpoints using Stata14 and RevMan5.4, with network evidence plots, league tables, and funnel plots generated as part of the assessment.

Safety Outcomes

Among safety outcomes, dupilumab showed a statistically lower incidence of serious adverse events compared with placebo (RR = 0.43; 95% CI, 0.30–0.63). No other monoclonal antibody demonstrated statistically significant differences in serious adverse events compared with placebo.

Clinical Implications

Authors concluded that all monoclonal antibodies assessed performed better than placebo, with the overall evidence supporting spesolimab, rademikibart, dupilumab, and amlitelimab as recommended treatment options based on efficacy and safety.

"This study is the first to comprehensively evaluate all clinically approved monoclonal antibodies for the treatment of moderate-to-severe [AD], filling a gap in the existing literature," investigators concluded.

Source: Cai W, Fu L, Wu Y, Yao Y, Zhang J. Efficacy and safety of all monoclonal antibodies in moderate-to-severe atopic dermatitis: A systematic review and network meta-analysis. Pharmacoepidemiol Drug Saf. Published online December 5, 2025. doi:10.1002/pds.70268