Novel nonsteroidal topical therapies for pediatric atopic dermatitis: a systematic review and network meta-analysis of randomized controlled trials
Abstract
Background: Novel nonsteroidal topical therapies are increasingly used for pediatric atopic dermatitis (AD), but their comparative efficacy and safety remain unclear because direct active-comparator evidence is limited.
Methods: We conducted a systematic review and frequentist network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating novel nonsteroidal topical therapies in children with AD. The study was registered in PROSPERO (CRD420261400624). Efficacy outcomes included Investigator's Global Assessment treatment success (IGA-TS), Eczema Area and Severity Index 75 response (EASI-75), and EASI-90. Safety outcomes included treatment-emergent adverse events (TEAEs) and treatment-related adverse events (TRAEs). Treatment nodes were defined by drug, concentration, and dosing frequency. Pairwise vehicle-controlled meta-analyses, sensitivity analysis, and subgroup analyses by treatment duration and age were also performed.
Results: Twelve articles reporting 15 RCTs involving 3,994 pediatric patients were included. The network was largely centered on vehicle, with only one active-comparator trial. Most active regimens improved IGA-TS versus vehicle, except tapinarof 0.5% once daily. For EASI-75, five of ten evaluated active regimens showed significant benefit, while all six regimens evaluated for EASI-90 were superior to vehicle. Delgocitinib 0.5% twice daily ranked highest for IGA-TS and EASI-75, whereas difamilast 1% twice daily ranked highest for EASI-90. No…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,994 participants or records.
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