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Comparative effectiveness and safety of phototherapy, cytotoxic agents, and biologics in adults with atopic dermatitis: real-world multicenter cohort data.

Created on 09 Mar 2026

Authors

Amr Molla, Raed Jannadi

Published in

The Journal of dermatological treatment. Volume 37. Issue 1. Pages 2639945. Epub Mar 09, 2026.

Abstract

Real-world comparative evidence on systemic agents, phototherapy, and biologics for atopic dermatitis (AD) remains limited.
To compare 24-week effectiveness and safety of methotrexate (MTX), cyclosporine, narrowband ultraviolet B (NB-UVB) phototherapy, upadacitinib, and dupilumab in adults with AD.
In this multicenter retrospective cohort (N = 1000; 200 per monotherapy group) across Saudi Arabia, SCORAD was extracted at baseline and mapped to prespecified weeks 2, 6, 12, and 24. Confounding was addressed using a multinomial propensity score (baseline SCORAD, age, sex, nationality) with overlap weighting; balance was assessed using Max |SMD|. Longitudinal change from baseline (ΔSCORAD) was analyzed using overlap-weighted generalized estimating equations with a treatment-by-time interaction, reporting adjusted marginal mean ΔSCORAD (95% CI).
Unadjusted 24-week improvement was highest with dupilumab (75.8%) and upadacitinib (74.1%) (p < 0.001). In overlap-weighted models, both were associated with the largest week-24 improvements (ΔSCORAD -27.04 and -26.68). NB-UVB and methotrexate were intermediate, whereas cyclosporine had smaller sustained improvement. Upadacitinib had the highest recorded adverse-event frequency (68.5%), whereas dupilumab had the lowest (9%).
Dupilumab and upadacitinib were associated with larger 24-week SCORAD improvements than conventional systemic therapies and NB-UVB within this stratified analytic cohort. Results are associative and may be affected by residual confounding.

PMID:
41800711
Bibliographic data and abstract were imported from PubMed on 09 Mar 2026.

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