Comparative efficacy of biologics and small molecule drugs in treating pediatric atopic dermatitis in patients aged 2–18 years: A 12–16 week network meta‐analysis of randomized controlled trials

Atopic dermatitis (AD) predominantly manifests before age five, with significant phenotype variations across age groups. Despite increasing systemic treatments for pediatric AD, head-to-head comparisons in network meta-analyses focused on children are scarce. Through systematic searches of PubMed, Embase, Web of Science, and Cochrane Library up to March 2024, we identified randomized controlled trials (RCTs) evaluating systemic treatments for moderate-to-severe AD in children aged 2-18 years. From 900 screened articles, 8 RCTs (n = 2636) met inclusion criteria, comparing dupilumab, baricitinib, upadacitinib, and abrocitinib versus placebo with standard care. Primary outcome was Eczema Area and Severity Index (EASI) scores at 12-16 weeks. Upadacitinib demonstrated highest efficacy at both 30 mg (risk difference [RD] 0.62 [0.53, 0.71]) and 15 mg (RD 0.52 [0.42, 0.62]). Dupilumab (weight-based dosing with corticosteroids; RD 0.43 [0.29, 0.57]), abrocitinib (200 mg; RD 0.40 [0.29, 0.50]; 100 mg; RD 0.30 [0.20, 0.41]), and baricitinib (4 mg; RD 0.21 [0.06, 0.35]) also showed significant efficacy over placebo. This analysis establishes a hierarchy of effectiveness among systemic therapies for pediatric AD, with upadacitinib showing highest efficacy. However, the predominance of adolescent data emphasizes the need for age-stratified studies in younger children and long-term safety assessments.