Topical treatments for atopic dermatitis (eczema): systematic review and network meta-analysis of randomized trials
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Publisher version
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 remissionitchlotamilastmaintenance of remissionnetwork meta-analysispatient-important outcomespimecrolimusquality of lifereactive vs proactive therapyroflumilastruxolitinibsleeptacrolimustopical JAK inhibitorstopical antibioticstopical calcineurin inhibitorstopical corticosteroidstopical phosphodiesterase-4 (PDE-4) inhibitorstopical treatments
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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.Scopus Count
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