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Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials.
Chu, Derek K; 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.
Affiliation
  • Chu DK; Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Canada. Electro
  • Chu AWL; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Rayner DG; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Guyatt GH; Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Yepes-Nuñez JJ; Universidad de Los Andes, Bogotá, Colombia; Fundacion Santa Fe de Bogotá University, Bogotá, Colombia.
  • Gomez-Escobar L; Universidad de Los Andes, Bogotá, Colombia.
  • Pérez-Herrera LC; Universidad de Los Andes, Bogotá, Colombia.
  • Díaz Martinez JP; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Brignardello-Petersen R; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
  • Sadeghirad B; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Anesthesia, McMaster University, Hamilton, Canada.
  • Wong MM; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Ceccacci R; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Zhao IX; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Basmaji J; Department of Medicine, Western University, London, Canada.
  • MacDonald M; Department of Medicine, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Chu X; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada.
  • Islam N; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
  • Gao Y; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University, Hamilton, Canada; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Qatar.
  • Izcovich A; Servicio de Clínica Médica, Hospital Aleman, Buenos Aires, Argentina.
  • Asiniwasis RN; Department of Dermatology, University of Saskatchewan, Regina, Canada.
  • Boguniewicz M; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colo; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
  • De Benedetto A; Department of Dermatology, University of Rochester Medical Center, Rochester, NY.
  • Capozza K; Global Parents for Eczema Research, Santa Barbara, Calif.
  • Chen L; Evidence in Allergy Group, McMaster University, Hamilton, Canada; Department of Pediatrics, McMaster University, Hamilton, Canada.
  • Ellison K; Westerville, Ohio.
  • Frazier WT; Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pa.
  • Greenhawt M; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colo; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colo.
  • Huynh J; Sepulveda VA Medical Center, North Hills, Calif.
  • LeBovidge J; Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
  • Lio PA; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
  • Martin SA; UMass Chan Medical School, Worcester, Mass.
  • O'Brien M; Tufts University School of Medicine, Boston, Mass.
  • Ong PY; Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, Calif; Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, Calif.
  • Silverberg JI; Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
  • Spergel JM; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.
  • Smith Begolka W; National Eczema Association, Novato, Calif.
  • Wang J; Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Wheeler KE; Department of Pediatrics, University of Florida, Gainesville, Fla.
  • Gardner DD; Allergy & Asthma Network, Fairfax, Va.
  • Schneider L; Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
J Allergy Clin Immunol ; 152(6): 1493-1519, 2023 12.
Article in En | MEDLINE | ID: mdl-37678572
ABSTRACT

BACKGROUND:

Atopic dermatitis (AD) is a common skin condition with multiple topical treatment options, but uncertain comparative effects.

OBJECTIVE:

We sought to systematically synthesize the benefits and harms of AD prescription topical treatments.

METHODS:

For 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).

RESULTS:

The 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.

CONCLUSIONS:

For 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.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Asthma / Dermatitis, Atopic / Dermatologic Agents / Eczema Type of study: Clinical_trials / Guideline / Systematic_reviews Aspects: Patient_preference Limits: Humans Language: En Journal: J Allergy Clin Immunol Year: 2023 Document type: Article
Fulltext
Add to My VHL
Print
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PubMed Links
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Asthma / Dermatitis, Atopic / Dermatologic Agents / Eczema Type of study: Clinical_trials / Guideline / Systematic_reviews Aspects: Patient_preference Limits: Humans Language: En Journal: J Allergy Clin Immunol Year: 2023 Document type: Article