PDG6 A SYSTEMATIC LITERATURE REVIEW AND NETWORK META-ANALYSIS (NMA) OF CRISABOROLE 2% OINTMENT FOR THE TREATMENT OF MILD-TO-MODERATE ATOPIC DERMATITIS (AD)

Abstract

To evaluate the comparative efficacy of crisaborole 2% versus other topical pharmacologic therapies among children (≥ 2 years) and adults with mild-to-moderate AD. MEDLINE, Embase, Cochrane, and the Database of Abstracts of Reviews of Effects were searched from inception to 03/04/2019, for randomized clinical trials reporting the efficacy of topical calcineurin inhibitors, topical corticosteroids, or crisaborole. The outcome of interest was treatment success: achieving an Investigator's Static Global Assessment (ISGA) score of 0-1 (clear or almost clear AD) at 28-43 days, with 28-29 day data used preferentially. A Bayesian model adjusting for baseline risk (variation in vehicle response rates) was used; in addition, the model included class effects (tacrolimus and pimecrolimus in one class; crisaborole in its own class). A complementary log-log model accounted for differential follow-up times. 9 RCTs were included in the NMA. The population included both pediatric and adult patients. Patients on crisaborole 2%, tacrolimus 0.03% and 0.1% were significantly more likely to achieve treatment success at 28-43 days versus vehicle with the largest point estimate observed for the crisaborole 2% comparison (hazard ratio [HR]: 2.07 [95% CrI: 1.76; 2.36]). Patients on crisaborole 2% were more likely to achieve treatment success versus pimecrolimus 1% [HR: 1.62 [95% CrI: 1.04; 2.48]. While the point estimates favored crisaborole 2%, there were no significant differences between crisaborole 2%, tacrolimus 0.03% and 0.1% with respect to treatment success at 28-43 days. The baseline risk model found that the relationship between vehicle rate and relative treatment effect versus vehicle was highly significant (slope = -0.89 [95% CrI: -1.26; -0.47]), making results versus vehicle highly sensitive to vehicle rate chosen (not observed versus other active treatments). Crisaborole 2% was superior to vehicle and pimecrolimus 1%, and comparable to tacrolimus 0.03% and 0.1% in achieving treatment success at 28-43 days.