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22 April 2020

Researchers rank effective systemic treatments for eczema

A wide-ranging study has compared systemic treatments for eczema for the first time.

eczema treatments

The findings, published today in JAMA Dermatology, by researchers from King’s and The University of Toronto, have reviewed 39 trials with 6,360 patients, and found that dupilumab, a new, biologic treatment, and cyclosporine, an oral medication, have greater efficacy than other conventional systemic therapies.

Eczema, also called ‘atopic dermatitis’ or ‘atopic eczema’, is a very common chronic inflammatory disease and causes the skin to become dry, itchy and cracked. In severe cases, the disease often has a profound impact on patients’ quality of life, with constant itching which can lead to sleep disruption. There is also a strong association with anxiety and depression.

Eczema is a very disabling disease, when it is severe and not controlled by topical treatments alone. Until recently, we only had phototherapy and conventional immuno-suppressive treatments available. This is now changing rapidly, as more and more new systemic therapies are being tested in clinical trials, providing hope for eczema sufferers.

Prof Carsten Flohr from the School of Basic & Medical Biosciences and senior author on the publication

The study found that dupilumab and cyclosporine improve clinical signs, itch and quality of life for patients compared to methotrexate and azathioprine.

Until now, only very few treatments for eczema have been directly compared in clinical trials. This is why the team have taken a statistical approach called a ‘network meta-analysis’, which allows comparisons of different treatments, even if they were not assessed in the same study.

Dr Aaron Drucker, University of Toronto, said: “Network meta-analysis is an empowering research tool that allows us to make comparisons we might never see in a head-to-head trial. We may never see a baricitinib vs dupilumab trial, but we are still able to compare them. We hope that our website makes our scientifically complex results easier to use for patients and clinicians deciding between treatments.”

The full results have been published on and will be updated with new findings on a regular basis, making this a ‘living’ project.

The website has been designed for physicians and patients with more severe eczema, so that they can make comparisons between different treatment options available to them.

In this story

Carsten  Flohr

Head, Paediatric & Population-Based Dermatology Research, St John's Institute of Dermatology