Background Numerous emerging systemic therapies, including monoclonal antibodies and Janus kinase (JAK) inhibitors, are effective for atopic dermatitis (AD). However, their effects on the incidence of airway comorbidities like asthma and allergic rhinitis in AD patients remain unclear. This network meta-analysis evaluates and compares the risks of these adverse events among patients with AD receiving different biologics and systemic JAK inhibitors. Methods PubMed, Cochrane Library, Embase, and Web of Science were searched for randomized controlled trials (RCTs) evaluating asthma and allergic rhinitis in AD patients receiving JAK inhibitors or biologics, from inception to January 4, 2025. Data synthesis employed a Bayesian network meta-analysis with random-effects modeling, using relative risk (RR) and 95% credible intervals (CI) as effect measures. Meta-regression assessed the impact of study design and participant characteristics on intervention effectiveness. The surface under the cumulative ranking curve (SUCRA) ranked intervention safety profiles, and methodological quality was appraised via the Cochrane ROB 2.0 tool. Results A total of 26 randomized clinical trials (13,069 participants) met inclusion criteria, with 9530 receiving JAK inhibitors/biologics and 3540 assigned to placebo. Compared to nemolizumab 90 mg, dupilumab 300 mg (RR = 0.1, 95% CI: 0.01, 0.93) and tralokinumab 150 mg (RR = 0.03, 95% CI: 0, 0.77) were associated with a significantly lower risk of asthma. SUCRA analysis identified ISB 830 600 mg (SUCRA = 8.0%) as the highest for asthma-related adverse events and tralokinumab 150 mg (SUCRA = 95.1%) as the lowest. For allergic rhinitis, abrocitinib 100 mg had the highest adverse event incidence (SUCRA = 10.3%) and dupilumab 200 mg the lowest (SUCRA = 93.8%). Cluster analysis confirmed dupilumab 200 mg as associated with the lowest combined risk of both conditions, while abrocitinib 100 mg had the highest. Conclusions Among patients with AD receiving biologics or JAK inhibitors, dupilumab was associated with the lowest risk of asthma and allergic rhinitis in our analysis. Owing to confounding between dose and patient factors (age, disease severity, etc.) in included trials, no specific dose recommendations can be made. These findings warrant confirmation by future large-scale RCTs stratified by age and dose. Trial registration PROSPERO (CRD42024595904).
Zeng et al. (Sat,) studied this question.