Original Title: Dupilumab en dermatitis atópica no controlada con terapia tópica

Authors' recommendations: No studies directly comparing dupilumab with other systemic therapeutic options (cyclosporine A, methotrexate, azathioprine and mycophenolate mofetil) in moderate to severe atopic dermatitis not adequately controlled with topical therapies, as first line systemic therapy, have been found. Low quality evidence from an indirect comparison suggests that dupilumab would improve quality-of-life-related outcomes when compared to azathioprine, while there would not be differences in quality of life and pruritus versus cyclosporine A and methotrexate in adults with moderate to severe atopic dermatitis not adequately controlled with topical therapies, as first or second systemic treatment option. High-quality evidence shows that dupilumab in combination with topical corticosteroids in adult patients with severe atopic dermatitis not responding to topical therapies and not adequately controlled, with intolerance to or contraindication for cyclosporine A (second systemic treatment option), clinically significantly improves scores in clinical response and quality of life scales after four-month follow up when compared with placebo. Low-quality evidence from the already mentioned indirect comparison in adult patients with severe atopic dermatitis not responding to topical therapies as first or second systemic treatment of choice suggests that dupilumab would improve quality-of-life related outcomes and pruritus when compared to azathioprine, while there would be no differences in quality of life and pruritus versus cyclosporine A and methotrexate. Low-quality evidence suggests that dupilumab in combination with topical corticosteroids in adult patients with severe atopic dermatitis not responding to topical therapies and not adequately controlled, with intolerance to or contraindication for cyclosporine A and other systemic therapies available, would clinically significantly improve the scores in clinical response and quality of life scales at four-month follow up when compared with other systemic therapies available. One clinical practice guideline and two consensuses of Latin American experts consider the use of dupilumab in moderate to severe atopic dermatitis, as well as other alternatives, for those patients for whom topical treatment is not enough and in whom other systemic treatments have not responded or have not been adequate. One consensus of experts from Europe includes its use for severe atopic dermatitis controlled with topical therapies, while other two consensuses from Canada and Australasia mention it as an option in moderate to severe disease. No Latin American country covers this technology for the assessed indication, while of the high-income countries surveyed five cover it and one of them does not mention it. In three cost-effectiveness studies from high-income countries comparing dupilumab with the standard of care in adults with moderate to severe atopic dermatitis not adequately controlled with topical therapies, it was not cost-effective for the thresholds defined by these countries. It is considered an expensive technology. None of the Latin-American countries surveyed cover this technology for the assessed indication, while among the high-income countries surveyed, five cover it and one does not mention it.

Project Status: Completed

Year Published: 2020

URL for published report: https://www.iecs.org.ar/home-ets/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)