Application of Topical Phosphodiesterase 4 Inhibitors in Mild to Moderate Atopic Dermatitis: A Systematic Review and Meta-analysis

Huan Yang, Ji Wang, Xin Zhang, Yan Zhang, Zi-Li Qin, Hua Wang, Xiao-Yan Luo

DOI: 10.1001/jamadermatol.2019.0008

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• What is this paper about?

  This is a systematic review and meta-analysis examining the effectiveness and safety of topical phosphodiesterase 4 (PDE4) inhibitors for treating mild to moderate atopic dermatitis. The study analyzed data from clinical trials comparing PDE4 inhibitors to vehicle (placebo) treatments.

• How did the authors study this?

  The researchers systematically searched multiple medical databases for randomized controlled trials comparing topical PDE4 inhibitors to vehicle treatments. They included 7 studies with 1,869 total patients. They analyzed changes in target lesion scores and investigators' assessments of skin clearance, as well as safety outcomes.

• What populations did the authors study?

  The studies included both children and adults with mild to moderate atopic dermatitis. Ages ranged from 2 to 75 years old. Five different PDE4 inhibitors were studied: crisaborole, AN2898, E6005, OPA-15406, and roflumilast.

• What did the authors find?

  Overall, PDE4 inhibitors showed significant improvement compared to vehicle treatments in reducing target lesion scores and achieving clear/almost clear skin. The best results were seen with crisaborole and AN2898 when used for 14-28 days. Side effects were generally mild and included application site reactions like burning or stinging. There was no significant difference in adverse events between PDE4 inhibitors and vehicles.

• What conclusions can we draw?

  The authors concluded that topical PDE4 inhibitors, especially crisaborole and AN2898, are safe and effective for treating mild to moderate atopic dermatitis. They work best when used for maintenance therapy over 2-4 weeks. More research is needed on both shorter-term and longer-term use, using more comprehensive measurement tools.