P133 Improvements in sleep among people with atopic dermatitis: a systematic review of randomized clinical trial evidence and outcomes for biologic treatments

Abstract

Sleep disturbance is common in people with atopic dermatitis (AD) and significantly affects patients’ quality of life, yet evidence for effective interventions remains limited. We conducted a systematic review summarizing the effects of interventions (including advanced systemic therapies) on sleep outcomes in people with AD. Randomized controlled trials of pharmacological, nonpharmacological or combined interventions for people with AD reporting at least one sleep-related outcome were eligible. Searches of five databases (inception to 2025) and backward citation screening were conducted, with data on study characteristics, interventions and outcomes extracted and synthesized. This review was conducted following the PRISMA guidelines (PROSPERO registration: CRD420251071779). Our searches identified 5478 references, yielding 134 eligible trials. Of these, 26 were parallel-design studies investigating biologics: 10 dupilumab, 6 nemolizumab, 5 tralokinumab, 3 lebrikizumab, 1 ustekinumab and 1 ligelizumab. The total number of randomized individuals was 9961. Assessment of sleep outcomes was heterogeneous, using a variety of tools. Three studies used actigraphy and most outcomes were patient reported via sleep diaries or questionnaires, including the sleep component of SCORing Atopic Dermatitis (SCORAD) and Patient-Oriented Eczema Measure. Only one study designated sleep outcomes as its primary endpoint. Overall, biologic-treated individuals showed significant improvements in one or more sleep outcomes over placebo in nearly all studies, including better sleep quality and continuity, and reduced sleep disturbance and daytime sleepiness. For example, biologic- vs. placebo-treated patients reported a 15.5% improvement in their sleep quality numerical rating scale (NRS) and 2.1/10 point improvement in their SCORAD sleep score in one study at 12 weeks. Two other studies reported 17.5% and 17.9% higher proportions of biologic-treated patients achieving ≥ 4-point improvement in the sleep disturbance NRS (0–10) at 16 weeks. These findings demonstrate that biologics improve sleep outcomes in people with AD alongside their skin effects. Further targeted research is needed to characterize their impact on this endpoint.