A comprehensive search was conducted using PubMed, Medline, Embase, Web of Science, Clinical Trials Website and Cochrane Library databases from inception to 18 February 2024. The review included all randomised controlled trials examining the efficacy of upadacitinib in the management of moderate to severe atopic dermatitis in adolescent patients. The methodological quality of the selected studies was thoroughly assessed using the Cochrane systematic review methodology.
Statistical analyses of outcome measures were performed using Review Manager 5.3 software.
A total of 4 studies were included in the meta-analysis.
Compared to placebo, upadacitinib at doses of 15 and 30 mg was associated with a significant improvement in eczema area and severity index of 75% ([odds ratio, OR = 11.06, 95% confidence interval, CI (6.78-18.04), P < .00001]; [OR = 21.73, 95% CI (12.73-37.11), P < . 00001]), a reduction in numerical rating scale >=4 ([OR = 6.16, 95% CI (3.56-10.64), P < .00001]; [OR = 10.58, 95% CI (6.12-18.29), P < . 00001]), and improvement in overall investigator assessment at 0/1 ([OR = 8.85, 95% CI (4.86-16.10), P < .00001]; [OR = 21.43, 95% CI (11.64-39.46), P < .00001]).
In terms of safety, upadacitinib 15 and 30 mg was associated with a statistically significant increase in the overall incidence of adverse events compared to placebo ([OR = 1.57, 95% CI (1.01-2.44), P = 0.04]; [OR = 2.21, 95% CI (1.44-3.41), P = 0.0003]). However, no statistically significant difference was found in the occurrence of serious adverse events between upadacitinib and placebo ([OR = 1.02, 95% CI (0.27-3.84), P = 0.98]; [OR = 0.42, 95% CI (0.09-1.93), P = 0.26]).
CONCLUSION: The results of this meta-analysis indicate that upadacitinib demonstrates substantial efficacy and tolerability in the treatment of moderate to severe atopic dermatitis in adolescents. In addition, upadacitinib provides a rapid reduction in pruritus and a marked improvement in symptoms and signs, with the 30 mg dose having a more pronounced therapeutic effect than the 15 mg dose.
