Summary

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• This summary is based on the review of 10 systematic review(s)/meta-analysis(es). ^[1-10]
• Patient-Reported Symptoms: Crisaborole was ranked among the least effective treatments for improving patient-reported symptoms in atopic dermatitis, while tacrolimus 0.1%, potent topical corticosteroids (TCS), and ruxolitinib 1.5% were identified as the most effective options (low confidence). Comparatively, crisaborole showed less effectiveness than tacrolimus 0.03% and very potent TCS (moderate confidence).
• Clinician-Reported Signs: Crisaborole was also among the least effective in improving clinician-reported signs of atopic dermatitis, with treatments like potent TCS, tacrolimus 0.1%, and ruxolitinib 1.5% showing higher effectiveness. The most effective options were very potent TCS and tacrolimus 0.03% (moderate confidence).
• Investigator Global Assessment (IGA): For achieving IGA 0/1, crisaborole was less effective than ruxolitinib 1.5%, delgocitinib 0.5%, and very potent TCS, among others. Additionally, pimecrolimus, roflumilast, and difamilast were also less effective compared to these more potent treatments.
• Early Response Predictors: Among those under 12 years old, patients with moderate baseline disease and shorter disease duration responded earlier to crisaborole, which served as a predictor of better response at day 29.
• Application Site Reactions: Crisaborole was among the treatments most likely to cause application site reactions, with a high confidence level, while tacrolimus 0.1%, tacrolimus 0.03%, and pimecrolimus also had higher reaction rates compared to TCS, which were least likely to cause these reactions.
• Skin and Pigmentation Changes: Short-term use of TCS did not result in increased skin thinning; however, prolonged use of mild to potent TCS was associated with a greater risk of skin thinning than topical calcineurin inhibitors (TCI). Neither crisaborole nor TCS were associated with increased pigmentation changes (low confidence).
• Pediatric Safety: Steroid-sparing treatments like crisaborole were found safe with minimal adverse events for pediatric atopic dermatitis (AD), though burning and pruritus were more frequent compared to TCS.
• Crisaborole demonstrated effectiveness and safety across specific populations, including children under 12 years, where it showed early response potential, particularly in cases of moderate baseline disease; it was also noted as safe for use on sensitive skin areas, similar to pimecrolimus and tacrolimus 0.03%, with no transient epidermal thinning. Additionally, crisaborole and TCI were safe options for geriatric patients, minimizing the risk of skin atrophy seen with TCS.