Very potent and potent topical corticosteroids, tacrolimus 0.1%, and topical Janus kinase inhibitors were the most effective short-term treatments for atopic dermatitis, according to a network meta-analysis published in JAMA Dermatology.
In contrast, phosphodiesterase-4 inhibitors (PDE-4) such as crisaborole and roflumilast showed the least efficacy for symptom relief. Short-term topical corticosteroid use was not associated with skin thinning, while tacrolimus, pimecrolimus, and crisaborole most often caused application-site irritation.
The analysis included 291 randomized clinical trials involving 45,846 participants with atopic dermatitis (AD) of any severity, conducted primarily in high-income countries. Study durations ranged from 2 to 16 weeks, with a median of 3 weeks. Researchers combined direct and indirect comparisons through network meta-analysis to evaluate the relative effectiveness and safety of topical anti-inflammatory agents, including corticosteroids, calcineurin inhibitors, PDE-4 inhibitors, Janus kinase (JAK) inhibitors, and aryl hydrocarbon receptor activators.
Across both clinician- and patient-reported outcomes, potent and very potent corticosteroids consistently outperformed other topical agents, providing the greatest improvement in visible signs and reported symptoms. Tacrolimus 0.1% and JAK inhibitors such as ruxolitinib and delgocitinib showed comparable efficacy, while mild corticosteroids and PDE-4 inhibitors produced the most minorw improvements.
Local adverse events such as application-site irritation occurred more frequently with calcineurin inhibitors and crisaborole, though most cases were mild. In long-term corticosteroid use, ranging from 6 to 60 months, corticosteroid-related skin thinning was low, observed in only 6 of 4069 participants.
Rachel Zhang, BS, and Joy Wan, MD, MSCE, of Johns Hopkins University noted that while these findings provide a comprehensive comparison to date of topical anti-inflammatory agents for AD “as new AD treatments continue to emerge, further head-to-head trials with longer follow-up and in real-world settings will be crucial for guiding care.”
Source: JAMA Dermatology
