Efficacy and safety of dupilumab for moderate-to-severe atopic dermatitis: A systematic review for the EAACI biologicals guidelines

Ioana Agache, Yang Song, Margarita Posso, Pablo Alonso-Coello, Claudio Rocha, Ivan Solà, Jessica Beltran, Cezmi A. Akdis, Mubeccel Akdis, Knut Brockow, Tomas Chivato, Stefano del Giacco, Thomas Eiwegger, Kilian Eyerich, Ana Giménez-Arnau, Jan Gutermuth, Emma Guttman-Yassky, Marcus Maurer, Graham Ogg, Peck Y. OngLiam O’Mahony, Jürgen Schwarze, Thomas Werfel, Carlos Canelo-Aybar, Oscar Palomares, Marek Jutel

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42 Scopus citations


This systematic review evaluates the efficacy, safety and economic impact of dupilumab compared to standard of care for uncontrolled moderate-to-severe atopic dermatitis (AD). Pubmed, EMBASE and Cochrane Library were searched for RCTs and health economic evaluations. Critical and important AD-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Seven RCTs including 1845 subjects >12 years treated with dupilumab 16 to 52 weeks were evaluated. For adults, there is high certainty that dupilumab decreases SCORAD (MD −30,72; 95% CI −34,65% to −26,79%) and EASI-75 (RR 3.09; 95% CI 2.45 to 3.89), pruritus (RR 2.96; 95% CI 2.37 to 3.70), rescue medication (RR 3.46; 95% CI 2.79 to 4.30), sleep disturbance (MD −7.29; 95% CI −8.23 to −6.35) and anxiety/depression (MD −3.08; 95% CI −4.41 to −1.75) and improves quality of life (MD −4.80; 95% CI −5.55 to −4.06). The efficacy for adolescents is similar. Dupilumab-related adverse events (AEs) slightly increase (low certainty). The evidence for dupilumab-related serious AE is uncertain. The incremental cost-effectiveness ratio ranged from 28 500 £ (low certainty) to 124 541 US$ (moderate certainty). More data on long-term safety are needed both for children and for adults, together with more efficacy data in the paediatric population. Registration: PROSPERO (CRD42020153645).

Original languageEnglish
Pages (from-to)45-58
Number of pages14
JournalAllergy: European Journal of Allergy and Clinical Immunology
Issue number1
StatePublished - Jan 2021


  • EASI
  • atopic dermatitis
  • cost-effectiveness
  • dupilumab


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