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A review in has found that four agents substantially improved pruritus and overall well-being among children with atopic dermatitis (AD).

The study was conducted by a team with the department of dermatology at Radboud University Medical Center in the Netherlands. The group ultimately included 30 studies in their systemic review and meta-analysis, collectively covering a range of medications.

The following study excerpts have been edited for length and clarity.

What prompted this review?

Itch, one of the hallmarks of AD, has a significant impact on the quality of life of pediatric AD patients and their caregivers. However, an overview of the antipruritic effects of available systemic AD treatments in pediatric patients has been lacking. This knowledge gap was the impetus for this review.

What were the key findings?

The most evidence of antipruritic effects emerged for cyclosporin A, dupilumab, abrocitinib, and upadacitinib. All afforded marked improvement of pruritus in pediatric AD. Pruritus decreased by 50% or more with cyclosporin A (in children ages 2-16 years), dupilumab (6 months-17 years), abrocitinib (12-17 years), and upadacitinib (12-17 years).

The highest odds ratio for achieving desired anti-itch response was found for dupilumab.

Nemolizumab was found to be promising in children 12-17 years old, but data were limited.

What were main findings for other treatments included in the analysis?

Most studies that evaluated oral antihistamines -- mainly chlorpheniramine, cetirizine, and fexofenadine -- found no antipruritic effects.

Researchers identified a single randomized controlled trial that evaluated itch control with glucocorticosteroids. The drug analyzed in that trial, flunisolide, caused a significant decrease in pruritus.

Melatonin was evaluated in two placebo-controlled trials included in the study. Neither trial showed a statistically significant impact on pruritus.

What are the key takeaways?

As several new treatment options for pediatric AD become available, clinicians will be able to incorporate antipruritic efficacy into therapeutic decision-making. This review provides the first overview of available evidence of antipruritic effects in this patient population.

In most studies included in the review, the decrease in pruritus was generally comparable to lower overall clinical severity scores. Other studies, however, found low-to-moderate correlations between itch and clinical outcome measurements. These low correlations emphasize the necessity of including itch measurements in future investigations and daily practice registries.