Network Meta-Analysis: Potent Corticosteroids, JAK Inhibitors, and Tacrolimus 0.1% Among the Most Effective Topical Treatments for Eczema – Cochrane Library

Study Design and Population: This network meta-analysis included 291 randomized controlled trials involving 45,846 participants with varying eczema severity. The trials primarily focused on adults in high-income countries and assessed various topical anti-inflammatory treatments over a median duration of 21 to 28 days. The study aimed to compare the efficacy and safety of these treatments.

Main Findings: Potent topical corticosteroids (TCS), JAK inhibitors, and tacrolimus 0.1% were consistently ranked as the most effective treatments for reducing eczema symptoms and signs. In contrast, phosphodiesterase-4 (PDE-4) inhibitors like crisaborole 2% and mild TCS were among the least effective. Notably, tacrolimus, pimecrolimus, and crisaborole were more likely to cause local adverse effects such as burning and stinging, while short-term TCS use did not show an increased risk of skin thinning, although long-term use did.

Implications for Practice: The findings suggest that potent TCS, JAK inhibitors, and tacrolimus 0.1% are effective for short-term eczema control. However, given the risk of skin thinning with long-term TCS use and potential adverse effects with certain treatments, clinicians should consider patient preferences, treatment availability, and cost when selecting therapies.

Reference: Cochrane Skin Group, et al. (2024). Topical anti-inflammatory treatments for eczema: network meta-analysis. Cochrane Database of Systematic Reviews. http://doi.org/10.1002/14651858.CD015064.pub2