Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials
BackgroundAtopic dermatitis (AD) is a common skin condition with multiple topical treatment options, but uncertain comparative effects. ObjectiveWe sought to systematically synthesize the benefits and harms of AD prescription topical treatments. MethodsFor the 2023 American Academy of Allergy, Asthm...
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2023
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| Online Access: | http://dx.doi.org/10.1016/j.jaci.2023.08.030 https://www.sciencedirect.com/science/article/pii/S0091674923011132 http://hdl.handle.net/10576/50632 |
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| _version_ | 1857415084362432512 |
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| author | Derek K., Chu |
| author2 | Chu, Alexandro W.L. Rayner, Daniel G. Guyatt, Gordon H. Yepes-Nuñez, Juan José Gomez-Escobar, Luis Pérez-Herrera, Lucia C. Díaz Martinez, Juan Pablo Brignardello-Petersen, Romina Sadeghirad, Behnam Wong, Melanie M. Ceccacci, Renata Zhao, Irene X. Basmaji, John MacDonald, Margaret Chu, Xiajing Islam, Nazmul Gao, Ya Izcovich, Ariel Asiniwasis, Rachel N. Boguniewicz, Mark De Benedetto, Anna Capozza, Korey Chen, Lina Ellison, Kathy Frazier, Winfred T. Greenhawt, Matthew Huynh, Joey LeBovidge, Jennifer Lio, Peter A. Martin, Stephen A. O’Brien, Monica Ong, Peck Y. Silverberg, Jonathan I. Spergel, Jonathan M. Smith Begolka, Wendy Wang, Julie Wheeler, Kathryn E. Gardner, Donna D. Schneider, Lynda |
| author2_role | author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| author_facet | Derek K., Chu Chu, Alexandro W.L. Rayner, Daniel G. Guyatt, Gordon H. Yepes-Nuñez, Juan José Gomez-Escobar, Luis Pérez-Herrera, Lucia C. Díaz Martinez, Juan Pablo Brignardello-Petersen, Romina Sadeghirad, Behnam Wong, Melanie M. Ceccacci, Renata Zhao, Irene X. Basmaji, John MacDonald, Margaret Chu, Xiajing Islam, Nazmul Gao, Ya Izcovich, Ariel Asiniwasis, Rachel N. Boguniewicz, Mark De Benedetto, Anna Capozza, Korey Chen, Lina Ellison, Kathy Frazier, Winfred T. Greenhawt, Matthew Huynh, Joey LeBovidge, Jennifer Lio, Peter A. Martin, Stephen A. O’Brien, Monica Ong, Peck Y. Silverberg, Jonathan I. Spergel, Jonathan M. Smith Begolka, Wendy Wang, Julie Wheeler, Kathryn E. Gardner, Donna D. Schneider, Lynda |
| author_role | author |
| dc.creator.none.fl_str_mv | Derek K., Chu Chu, Alexandro W.L. Rayner, Daniel G. Guyatt, Gordon H. Yepes-Nuñez, Juan José Gomez-Escobar, Luis Pérez-Herrera, Lucia C. Díaz Martinez, Juan Pablo Brignardello-Petersen, Romina Sadeghirad, Behnam Wong, Melanie M. Ceccacci, Renata Zhao, Irene X. Basmaji, John MacDonald, Margaret Chu, Xiajing Islam, Nazmul Gao, Ya Izcovich, Ariel Asiniwasis, Rachel N. Boguniewicz, Mark De Benedetto, Anna Capozza, Korey Chen, Lina Ellison, Kathy Frazier, Winfred T. Greenhawt, Matthew Huynh, Joey LeBovidge, Jennifer Lio, Peter A. Martin, Stephen A. O’Brien, Monica Ong, Peck Y. Silverberg, Jonathan I. Spergel, Jonathan M. Smith Begolka, Wendy Wang, Julie Wheeler, Kathryn E. Gardner, Donna D. Schneider, Lynda |
| dc.date.none.fl_str_mv | 2023-12-26T08:52:19Z 2023-12-31 |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://dx.doi.org/10.1016/j.jaci.2023.08.030 00916749 https://www.sciencedirect.com/science/article/pii/S0091674923011132 http://hdl.handle.net/10576/50632 1493-1519 6 152 |
| dc.language.none.fl_str_mv | en |
| dc.publisher.none.fl_str_mv | Elsevier |
| dc.rights.none.fl_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Atopic dermatitis (eczema) topical treatments (therapy) topical corticosteroids (steroids) topical calcineurin inhibitors (pimecrolimus, tacrolimus) topical phosphodiesterase-4 (PDE-4) inhibitors (crisaborole, difamilast, lotamilast, roflumilast) topical Janus kinase (JAK) inhibitors (ruxolitinib, delgocitinib) patient-important outcomes (eczema severity, intensity, itch, sleep, quality of life, flares or flare-ups or exacerbations) disease severity network meta-analysis (comparative effects) induction of remission and maintenance of remission (reactive or proactive therapy) |
| dc.title.none.fl_str_mv | Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials |
| dc.type.none.fl_str_mv | Article info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/article |
| description | BackgroundAtopic dermatitis (AD) is a common skin condition with multiple topical treatment options, but uncertain comparative effects. ObjectiveWe sought to systematically synthesize the benefits and harms of AD prescription topical treatments. MethodsFor the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT databases to September 5, 2022, for randomized trials addressing AD topical treatments. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-related quality of life, flares, and harms. The Grading of Recommendations Assessment, Development and Evaluation approach informed certainty of evidence ratings. We classified topical corticosteroids (TCS) using 7 groups—group 1 being most potent. This review is registered in the Open Science Framework (https://osf.io/q5m6s). ResultsThe 219 included trials (43,123 patients) evaluated 68 interventions. With high-certainty evidence, pimecrolimus improved 6 of 7 outcomes—among the best for 2; high-dose tacrolimus (0.1%) improved 5—among the best for 2; low-dose tacrolimus (0.03%) improved 5—among the best for 1. With moderate- to high-certainty evidence, group 5 TCS improved 6—among the best for 3; group 4 TCS and delgocitinib improved 4—among the best for 2; ruxolitinib improved 4—among the best for 1; group 1 TCS improved 3—among the best for 2. These interventions did not increase harm. Crisaborole and difamilast were intermediately effective, but with uncertain harm. Topical antibiotics alone or in combination may be among the least effective. To maintain AD control, group 5 TCS were among the most effective, followed by tacrolimus and pimecrolimus. ConclusionsFor individuals with AD, pimecrolimus, tacrolimus, and moderate-potency TCS are among the most effective in improving and maintaining multiple AD outcomes. Topical antibiotics may be among the least effective. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | qu_2a01c1aa71913c35728727add6d103d9 |
| identifier_str_mv | 00916749 1493-1519 6 152 |
| language_invalid_str_mv | en |
| network_acronym_str | qu |
| network_name_str | Qatar University repository |
| oai_identifier_str | oai:qspace.qu.edu.qa:10576/50632 |
| publishDate | 2023 |
| publisher.none.fl_str_mv | Elsevier |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| spelling | Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trialsDerek K., ChuChu, Alexandro W.L.Rayner, Daniel G.Guyatt, Gordon H.Yepes-Nuñez, Juan JoséGomez-Escobar, LuisPérez-Herrera, Lucia C.Díaz Martinez, Juan PabloBrignardello-Petersen, RominaSadeghirad, BehnamWong, Melanie M.Ceccacci, RenataZhao, Irene X.Basmaji, JohnMacDonald, MargaretChu, XiajingIslam, NazmulGao, YaIzcovich, ArielAsiniwasis, Rachel N.Boguniewicz, MarkDe Benedetto, AnnaCapozza, KoreyChen, LinaEllison, KathyFrazier, Winfred T.Greenhawt, MatthewHuynh, JoeyLeBovidge, JenniferLio, Peter A.Martin, Stephen A.O’Brien, MonicaOng, Peck Y.Silverberg, Jonathan I.Spergel, Jonathan M.Smith Begolka, WendyWang, JulieWheeler, Kathryn E.Gardner, Donna D.Schneider, LyndaAtopic dermatitis (eczema)topical treatments (therapy)topical corticosteroids (steroids)topical calcineurin inhibitors (pimecrolimus, tacrolimus)topical phosphodiesterase-4 (PDE-4) inhibitors (crisaborole, difamilast, lotamilast, roflumilast)topical Janus kinase (JAK) inhibitors (ruxolitinib, delgocitinib)patient-important outcomes (eczema severity, intensity, itch, sleep, quality of life, flares or flare-ups or exacerbations)disease severitynetwork meta-analysis (comparative effects)induction of remission and maintenance of remission (reactive or proactive therapy)BackgroundAtopic dermatitis (AD) is a common skin condition with multiple topical treatment options, but uncertain comparative effects. ObjectiveWe sought to systematically synthesize the benefits and harms of AD prescription topical treatments. MethodsFor the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT databases to September 5, 2022, for randomized trials addressing AD topical treatments. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-related quality of life, flares, and harms. The Grading of Recommendations Assessment, Development and Evaluation approach informed certainty of evidence ratings. We classified topical corticosteroids (TCS) using 7 groups—group 1 being most potent. This review is registered in the Open Science Framework (https://osf.io/q5m6s). ResultsThe 219 included trials (43,123 patients) evaluated 68 interventions. With high-certainty evidence, pimecrolimus improved 6 of 7 outcomes—among the best for 2; high-dose tacrolimus (0.1%) improved 5—among the best for 2; low-dose tacrolimus (0.03%) improved 5—among the best for 1. With moderate- to high-certainty evidence, group 5 TCS improved 6—among the best for 3; group 4 TCS and delgocitinib improved 4—among the best for 2; ruxolitinib improved 4—among the best for 1; group 1 TCS improved 3—among the best for 2. These interventions did not increase harm. Crisaborole and difamilast were intermediately effective, but with uncertain harm. Topical antibiotics alone or in combination may be among the least effective. To maintain AD control, group 5 TCS were among the most effective, followed by tacrolimus and pimecrolimus. ConclusionsFor individuals with AD, pimecrolimus, tacrolimus, and moderate-potency TCS are among the most effective in improving and maintaining multiple AD outcomes. Topical antibiotics may be among the least effective.Elsevier2023-12-26T08:52:19Z2023-12-31Articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://dx.doi.org/10.1016/j.jaci.2023.08.03000916749https://www.sciencedirect.com/science/article/pii/S0091674923011132http://hdl.handle.net/10576/506321493-15196152enhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:qspace.qu.edu.qa:10576/506322024-12-10T08:22:41Z |
| spellingShingle | Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials Derek K., Chu Atopic dermatitis (eczema) topical treatments (therapy) topical corticosteroids (steroids) topical calcineurin inhibitors (pimecrolimus, tacrolimus) topical phosphodiesterase-4 (PDE-4) inhibitors (crisaborole, difamilast, lotamilast, roflumilast) topical Janus kinase (JAK) inhibitors (ruxolitinib, delgocitinib) patient-important outcomes (eczema severity, intensity, itch, sleep, quality of life, flares or flare-ups or exacerbations) disease severity network meta-analysis (comparative effects) induction of remission and maintenance of remission (reactive or proactive therapy) |
| status_str | publishedVersion |
| title | Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials |
| title_full | Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials |
| title_fullStr | Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials |
| title_full_unstemmed | Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials |
| title_short | Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials |
| title_sort | Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials |
| topic | Atopic dermatitis (eczema) topical treatments (therapy) topical corticosteroids (steroids) topical calcineurin inhibitors (pimecrolimus, tacrolimus) topical phosphodiesterase-4 (PDE-4) inhibitors (crisaborole, difamilast, lotamilast, roflumilast) topical Janus kinase (JAK) inhibitors (ruxolitinib, delgocitinib) patient-important outcomes (eczema severity, intensity, itch, sleep, quality of life, flares or flare-ups or exacerbations) disease severity network meta-analysis (comparative effects) induction of remission and maintenance of remission (reactive or proactive therapy) |
| url | http://dx.doi.org/10.1016/j.jaci.2023.08.030 https://www.sciencedirect.com/science/article/pii/S0091674923011132 http://hdl.handle.net/10576/50632 |