We are upgrading the repository! A content freeze is in effect until December 6, 2024. New submissions or changes to existing items will not be allowed during this period. All content already published will remain publicly available for searching and downloading. Updates will be posted in the Website Upgrade 2024 FAQ in the sidebar Help menu. Reach out to escholarship@umassmed.edu with any questions.
Topical treatments for atopic dermatitis (eczema): systematic review and network meta-analysis of randomized trials
Name:
Publisher version
View Source
Access full-text PDFOpen Access
View Source
Check access options
Check access options
Authors
Chu, Derek KChu, 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
UMass Chan Affiliations
Family Medicine and Community HealthDocument Type
Journal ArticlePublication Date
2023-09-05Keywords
GRADEadverse events
atopic dermatitis
comparative effects
crisaborole
delgocitinib
difamilast
disease severity
eczema
flares (exacerbations)
induction of remission
itch
lotamilast
maintenance of remission
network meta-analysis
patient-important outcomes
pimecrolimus
quality of life
reactive vs proactive therapy
roflumilast
ruxolitinib
sleep
tacrolimus
topical JAK inhibitors
topical antibiotics
topical calcineurin inhibitors
topical corticosteroids
topical phosphodiesterase-4 (PDE-4) inhibitors
topical treatments
Metadata
Show full item recordAbstract
Background: Atopic dermatitis (AD) is a common skin condition with multiple topical treatment options, but uncertain comparative effects. Objectives: We systematically synthesized the benefits and harms of AD prescription topical treatments. Methods: For the 2023 AAAAI/ACAAI JTFPP AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT 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-quality of life, flares, and harms. The GRADE approach informed certainty of evidence ratings. We classified topical corticosteroids (TCS) using seven classes-group 1 being most potent. OSF: https://osf.io/q5m6s. Results: 219 included trials (43,123 patients) evaluated 68 interventions. With high-certainty, pimecrolimus improved six of seven outcomes-among the best for two; high-dose tacrolimus (0.1%) improved five-among the best for two; low-dose tacrolimus (0.03%) improved five-among the best for one. With moderate-to-high certainty, group 5 TCS improved six-among the best for three; group 4 TCS and delgocitinib improved four-among the best for two; ruxolitinib improved four-among the best for one; group 1 TCS improved three-among the best for two. These interventions did not increase harms. Crisaborole and difamilast were intermediately effective, but 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.Source
Chu DK, Chu AWL, Rayner DG, Guyatt GH, Yepes-Nuñez JJ, Gomez-Escobar L, Pérez-Herrera LC, Díaz Martinez JP, Brignardello-Petersen R, Sadeghirad B, Wong MM, Ceccacci R, Zhao IX, Basmaji J, MacDonald M, Chu X, Islam N, Gao Y, Izcovich A, Asiniwasis RN, Boguniewicz M, De Benedetto A, Capozza K, Chen L, Ellison K, Frazier WT, Greenhawt M, Huynh J, LeBovidge J, Lio PA, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Smith Begolka W, Wang J, Wheeler KE, Gardner DD, Schneider L. Topical treatments for atopic dermatitis (eczema): systematic review and network meta-analysis of randomized trials. J Allergy Clin Immunol. 2023 Sep 5:S0091-6749(23)01113-2. doi: 10.1016/j.jaci.2023.08.030. Epub ahead of print. PMID: 37678572.DOI
10.1016/j.jaci.2023.08.030Permanent Link to this Item
http://hdl.handle.net/20.500.14038/52652PubMed ID
37678572Rights
Copyright © 2023. Published by Elsevier Inc.ae974a485f413a2113503eed53cd6c53
10.1016/j.jaci.2023.08.030
Scopus Count
Collections
Related items
Showing items related by title, author, creator and subject.
-
Research collaboration between an HMO and an academic medical center: lessons learnedDonahue, Deirdre Carroll; Lewis, Barbara E.; Ockene, Ira S.; Saperia, Gordon M. (1996-02-01)Joint research ventures between health maintenance organizations (HMOs) and academic medical centers (AMCs) can strengthen both organizations from the research and patient care perspectives, by facilitating the exploration of views and cost-effective approaches to diagnoses and treatment. This article describes a research venture between the Fallon Healthcare System, a health maintenance organization (HMO), and the University of Massachusetts Medical Center, an academic medical center (AMC). This research venture, the Worcester Area Trial for Counseling Hyperlipidemia, was a four-year study in which 1,277 participants were recruited from 45 Fallon Clinic physician panels. The study targeted patients with blood cholesterol levels in the upper 25% of the cholesterol distribution. The different priorities and perspectives of the two institutions with regard to health care and research became more apparent as the study progressed. Eventually study personnel needed to re-examine the study objectives and each other's perspectives to accommodate these differences. This learning process showed that research ventures between HMOs and AMCs can prove mutually beneficial. An HMO can gain experience with large government-funded projects. AMCs can study managed care within a controlled setting. However, the differing priorities and perspectives of these institutions' organizational structures require that considerable attention be paid to their representatives' working relationships and perceptions.
-
Building blocks for meta-synthesis: data integration tables for summarising, mapping, and synthesising evidence on interventions for communicating with health consumersRyan, Rebecca E.; Kaufman, Caroline A.; Hill, Sophie J. (2009-03-06)BACKGROUND: Systematic reviews have developed into a powerful method for summarising and synthesising evidence. The rise in systematic reviews creates a methodological opportunity and associated challenges and this is seen in the development of overviews, or reviews of systematic reviews. One of these challenges is how to summarise evidence from systematic reviews of complex interventions for inclusion in an overview. Interventions for communicating with and involving consumers in their care are frequently complex. In this article we outline a method for preparing data integration tables to enable review-level synthesis of the evidence on interventions for communication and participation in health. METHODS AND RESULTS: Systematic reviews published by the Cochrane Consumers and Communication Review Group were utilised as the basis from which to develop linked steps for data extraction, evidence assessment and synthesis. The resulting output is called a data integration table. Four steps were undertaken in designing the data integration tables: first, relevant information for a comprehensive picture of the characteristics of the review was identified from each review, extracted and summarised. Second, results for the outcomes of the review were assessed and translated to standardised evidence statements. Third, outcomes and evidence statements were mapped into an outcome taxonomy that we developed, using language specific to the field of interventions for communication and participation. Fourth, the implications of the review were assessed after the mapping step clarified the level of evidence available for each intervention. CONCLUSION: The data integration tables represent building blocks for constructing overviews of review-level evidence and for the conduct of meta-synthesis. Individually, each table aims to improve the consistency of reporting on the features and effects of interventions for communication and participation; provides a broad assessment of the strength of evidence derived from different methods of analysis; indicates a degree of certainty with results; and reports outcomes and gaps in the evidence in a consistent and coherent way. In addition, individual tables can serve as a valuable tool for accurate dissemination of large amounts of complex information on communication and participation to professionals as well as to members of the public.
-
Prehospital delay in individuals with acute coronary disease: concordance of medical records and follow-up phone interviewsGoldberg, Robert J.; Osganian, Stavroula K.; Zapka, Jane G.; Mitchell, Paul; Bittner, Vera; Daya, Mo; Luepker, Russell V. (2002-06-22)Patient-associated delay in seeking medical care in persons with acute coronary disease is receiving increasing importance given the time-dependent benefits associated with myocardial reperfusion therapies. We examined the extent of concordance between self-reported information about prehospital delay provided by patients to hospital staff at the time of hospitalization for coronary disease compared with information obtained from a telephone interview approximately 2 months following hospital discharge. The sample included 316 patients with acute myocardial infarction or unstable angina at 43 hospitals who had delay time information available from both data sources. The extent of agreement between the medical record and telephone accounts of delay was 47% in the total study sample, 53% in patients with acute myocardial infarction, and 40% in patients with unstable angina. These results suggest that a telephone interview carried out several months following hospitalization for acute coronary disease may not provide sufficiently reliable information about prehospital delay.