Phosphodiesterase 4 Inhibitor Use in Pediatric Patients With Atopic Dermatitis: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE: To compare the clinical efficacy and safety of different topical phosphodiesterase 4 (PDE4) inhibitors for atopic dermatitis (AD) treatment in pediatric patients. DATA SOURCES: Clinical trials were identified from PubMed, Cochrane Library, EBSCO, Web of Science, and Ovid Medline databases until September 2023. STUDY SELECTION: Only randomized controlled trials (RCTs) with topical PDE4 inhibitors versus topical vehicle treatment for pediatric patients with mild-to-moderate AD were included. This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and was registered in PROSPERO. Data were pooled using the random-effects model if I 2 >50%. DATA EXTRACTION: Five RCTs were identified, which included 1877 pediatric patients with mild to moderate AD. DATA SYNTHESIS: Overall, compared with the topical vehicle control, PDE4 inhibitors were associated with higher response rate in Investigator Global Assessment scores (OR: 3.56, 95% CI: 2.09 to 6.04, P = .005) and increased treatment success rates at weeks 2 (OR: 4.09, 95% CI: 2.32 to 7.21, P < .00001) and weeks 4 (OR: 3.06, 95% CI: 1.52 to 6.18, P = .002). PDE4 inhibitors also associated with higher Eczema Area and Severity Index scores (OR: −4.11, 95% CI: −4.83 to 3.39, P < .00001). There were no significant differences in adverse events (OR: 1.16; 95% CI: 0.93 to 1.44, P = .18) or drug-related adverse events (OR: 1.46, 95% CI: 0.99 to 2.15, P = .05). CONCLUSIONS: PDE4 inhibitors might be an effective and safe treatment option for pediatric patients with AD.