Effect of systemic immunomodulatory therapies on mental health in atopic dermatitis: a systematic review and network meta-analysis

Background: Atopic dermatitis (AD) is a prevalent chronic skin condition that may cause significant mental health challenges, including anxiety and depression. This study aimed to evaluate the effects of different systemic immunomodulatory therapies on the anxiety and depression in patients with AD. Methods: We searched the MEDLINE (via Ovid, from 1946), EMBASE (via Ovid, from 1974), the Cochrane Central Register of Controlled Trials (CENTRAL), and the ClinicalTrials.gov from the date of their inception to June 1, 2024. We included randomized controlled trials (RCT) involving both children and adults with moderate-to-severe atopic AD receiving systemic immunomodulatory therapies. Network meta-analysis were performed using mean changes from baseline and their standard deviations (SDs) by Bayesian random effects model. All analyses were conduct using R version 3.6.3. Results: Eighteen RCTs reported in 15 studies involving 7,784 patients were eligible. The risk of bias of two outcomes reported in each trial were low or probably low. Measured by Hospital Anxiety and Depression Scale, high-certainty evidence demonstrated that “Abrocitinib (200 mg, oral, qd)” (anxiety: MD -1.2, 95%CI: -1.7 to -0.69; depression: MD -1.1, 95%CI: -1.8 to -0.29), “Dupilumab (300 mg, subcutaneously, q1w)” (anxiety: MD -1.9, 95%CI: -2.4 to -1.4, depression: MD -1.8, 95%CI: -2.7 to -0.85), “Dupilumab (300 mg, subcutaneously, q2w)” (anxiety: MD -1.7, 95%CI: -2.2 to -1.2; depression: MD -1.6, 95%CI: -2.3 to -0.76), and “Lebrikizumab (250 mg, subcutaneously, q2w)” (anxiety: MD -1.6, 95%CI: -2.3 to -0.97, depression: MD -1.6, 95%CI: -2.5 to -0.58), were the most effective drugs for both anxiety and depression in both adults and children patients, respectively; “Baricitinib (4 mg, oral, qd)” (MD -1.1, 95%CI: -1.9 to -0.34) was only efficient with depression. Conclusions: Systemic immunomodulatory therapy could significantly alleviate anxiety and depression in patients with AD, particularly with the subcutaneous administration of Dupilumab at a 300 mg dose.