Comparative efficacy of pediatric atopic dermatitis treatments: a network meta-analysis highlighting dupilumab and pimecrolimus for SCORAD and EASI improvement

Background Atopic Dermatitis (AD) in children is a common chronic skin condition characterized by dry, itchy and inflamed skin. Various treatments have been applied in the management of AD in children, but the differences in efficacy of different treatment options have not been systematically summarized. The aim of this study was to compare the efficacy of different treatments for atopic dermatitis in children by network meta-analysis. Methods We conducted a systematic literature search to select randomized controlled trials (RCTs) that met the inclusion criteria. Databases included PubMed, EMBASE, Cochrane Library, and Web of Science, with a March 10, 2025, search deadline. Certainty of evidence was graded using the CINeMA tool, and risk of bias was assessed using risk of bias 2.0. The efficacy of different treatment regimens was compared using Bayesian network meta-analysis with R software. The primary outcome indicators were the SCORAD (Clinical Score for Atopic Dermatitis) and EASI (Atopic Dermatitis Area and Severity Index) scores. Results Thirty-two randomized controlled trials (n=3961) were included. Meta-analysis showed Dupilumab was more effective than Melatonin, Probiotics, SCG, Synbiotic, and Vitamin D for SCORAD. Cumulative probability rankings indicated Dupilumab (96.0%), Tralokinumab (86.8%), and PEC (69.2%) as the top treatments. For EASI, Pimecrolimus, Dupilumab, and Nemolizumab were superior to Probiotics, with Pimecrolimus showing the highest efficacy (99.9%). Conclusion Dupilumab may offer greater benefits in reducing SCORAD scores, while Pimecrolimus appears to be more effective for improving EASI. These treatments show potential as favorable options for managing pediatric atopic dermatitis. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420250650919 , identifier CRD420250650919.