Many new systemic treatments for atopic dermatitis (AD) have been developed in the recent years. Among these treatments are antibodies to specific key elements of the known inflammatory cascade i.e. dupilumab snd tralokinumab as well as Janus kinase inhibitors (JAK-inhibitors) such as abrocitinib, baricitinib and upadacitinib. However, these treatments have only been compared to placebo rather than active comparators in most studies. The aim of this study was to to compare the efficacies of systemic treatments with dupilumab, tralokinumab and JAK inhibitors for the treatment of AD.

A systematic review following PRISMA guidlines was performed using Medline, EMBASE and Cochrane library. All Randomized controlled trials (RCTs) investigating the efficacy of systemic treatments for moderate-to-severe AD in adults were included. Primary outcomes were proportion of AD patients achieving 50%, 75%, and 90% in improvement in EASI score after dupilumab, tralokinumab or JAK inhibitors treatment in RCTs or HTH studies. 

Eighteen RCTs totaling 6042 patients were included. In monotherapy RCTs, upadacitinib 30 mg and abrocitinib 200 mg both once daily had the numerically highest efficacy regarding EASI-50, EASI-75 and EASI-90. In combination therapy RCTs, dupilumab 300 mg once daily and once every other week had highest efficacy regarding EASI-50, and abrocitinib 200 mg once daily had the highest score EASI-75 and EASI 90 (no study investigating upadacitinib regarding EASI-75 and EASI-90 was included, where combination therapy was allowed).

Abrocitinib and upadacitinib seem to have great potential in order to treat patients who have failed or had an inadequate response to therapy with corticosteroids. However, further studies are needed to determine the long-term efficacy of JAK inhibitors in adults with moderate-to-severe AD.