Background and Importance Several oral drugs for atopic dermatitis have been approved in recent years. However, there are no studies that directly compare these treatments.

Aim and Objectives To establish, through an indirect comparison (IC) against placebo, whether abrocitinib, baricitinib and upadacitinib can be considered equivalent alternatives in efficacy for the treatment of atopic dermatitis, when used as monotherapy.

Material and Methods A PubMed search was performed for pivotal clinical trials (CTs) of abrocitinib (200 mg/24h), baricitinib (4 mg/24h), and upadacitinib (30 mg/24h) for atopic dermatitis, as monotherapy. The main variable for comparison was the results of the EASI75 (Eczema Area and Severity Index) at week 16 after the start of treatment. With the results of the EASI75 (%), the relative risk (RR) compared to placebo was calculated. Finally, with these values, an IC of these drugs was performed using the Bucher method (ITC calculator, Indirect Treatment Comparisons, of the Canadian Agency for Health Technology Assessment). The results were analysed, seeing if there were statistically significant differences between these three drugs.

Results Five CTs were found, one with abrocitinib, two with baricitinib (CTB1, CTB2) and upadacitinib (CTU1, CTU2), all of them compared to placebo as a common comparator. All the studies presented a similar methodology. However, in the CT of abrocitinib, patients under 18 years of age were not included, while in upadacitinib (13.5%) and baricitinib (22%) they were. Moreover, in the abrocitinib CT the EASI75 is measured at 12 weeks while in the others at 16 weeks. These limitations for IC were eventually accepted. After applying the Bucher method, the following results were obtained:

OR (abrocitinib 200 mg vs baricitinib 4 mg) 0,53 [IC 95% 0,24–1,18]; p=0,12 (in CTB1) and 0,65 [IC 95% 0,27–1,54]; p=0,32 (in CTB2),

OR (abrocitinib 200 mg vs upadacitinib 30 mg) 0,92 [IC 95% 0,46–1,82]; p=0,81 (in CTU1) and 1,04 [IC 95% 0,52–2,08];p=0,92 (in CTU2),

OR (baricitinib 4 mg CTB1 vs upadacitinib 30 mg) 1,73 [IC 95% 0,98–3,07]; p=0,06 (in CTU1) and 1,95 [IC 95% 1,08–3,52]; p=0,03 (in CTU2),

OR (baricitinib 4 mg CTB2 vs upadacitinib 30 mg) 1,42 [IC 95% 0,73–2,73]; p=0,30 (in CTU1) and 1,6 [IC 95% 0,81–3,13]; p=0,17 (in CTU2).

Conclusion and Relevance According to the results obtained, it could be that Upadacitinib 30 mg presented greater efficacy than Baricitinib 4 mg as it is the only IC that has given a statistically significant difference. However, due to the aforementioned limitations, these results should be taken with caution and safety and efficiency criteria should also be taken into account.

Conflict of Interest No conflict of interest