Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis

Devasenapathy, Niveditha; Asiniwasis, Rachel Netahe; Boguniewicz, Mark; Ceccacci, Renata; Chen, Lina; Chu, Alexandro; Chu, Derek K.; Benedetto, Anna De; Frazier, Winfred; Greenhawt, Matthew; Huynh, Joey; Kim, Elaine; LeBovidge, Jennifer; Levine, Mitchell; Lin, Clement; Lind, Mary Laura; Lio, Peter; MacDonald, Margaret; Martin, Stephen A.; O’Brien, Monica; Ong, Peck Y.; Pyne, Lonnie; Schneider, Lynda C.; Silverberg, Jonathan I.; Spergel, Jonathan M.; Srivastava, Archita; Steen, Jeremy; Wang, Julie; Wen, Aaron; Wong, Melanie

doi:10.1016/s2352-4642(22)00283-8

Cited by 28 publications

(13 citation statements)

References 138 publications

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“…To date, we have assessed the certainty of evidence for the original version and the four updates of the living systematic review and NMA of randomised trials investigating the treatment of covid-19, which included more than 4000 comparisons in the latest version 9. Although the approach has not been formally tested yet, it has been successfully implemented in other systematic reviews with NMA 12131415…”

Section: Discussionmentioning

confidence: 99%

“…We then developed a spreadsheet (supplementary file 1) that allowed automation of some steps and made modifications based on informal feedback from eight reviewers in charge of assessing the certainty of evidence in the living systematic review and NMA of randomised trials looking at the prophylaxis and treatment of covid-19. The approach was then successfully implemented in other four systematic reviews with NMA 12131415. This article describes practical strategies, including rule setting and automation that can facilitate implementation of the GRADE approach for NMA.…”

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confidence: 99%

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A guide and pragmatic considerations for applying GRADE to network meta-analysis

Izcovich

Chu

Mustafa

et al. 2023

BMJ

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Assessing the certainty of evidence from network meta-analyses using the GRADE (grading of recommendations, assessment, development, and evaluations) approach requires not only a thorough understanding of the methods but also substantial workload for raters. This article describes how implementing practical strategies (including rule setting and automation) can facilitate efficient application of the GRADE approach to rating certainty of evidence in network meta-analyses while maintaining rigor. This article describes a stepwise strategy for proceeding through the process, including assessment of the certainty of direct, indirect, and NMA estimates; developing directions for each step in the process; implementation of rules to improve robustness of information appraisal to reduce workload; and alternatives for automation of some of the required steps. The presented approach includes a detailed description of every step of the process supported by figures, tables, and real life examples. To facilitate implementation of this process, a spreadsheet that incorporates automation of several of the steps described is also provided (https://www.covid19lnma.com/).

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A guide and pragmatic considerations for applying GRADE to network meta-analysis

Izcovich

Chu

Mustafa

et al. 2023

BMJ

Self Cite

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“…In addition, they carry a blackbox warning of cancer risk. However, studies during the past 20 years and a recent meta-analysis showed that TCI do not increase the risk of cancer [19,20,21 ▪ ].…”

Section: Conventional Management and Treatmentsmentioning

confidence: 99%

Recent advances in immunomodulators for atopic dermatitis

Yim

Ong

2023

Current Opinion in Pediatrics

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Purpose of review Conventional treatments of atopic dermatitis have been inadequate, especially in patients with moderate-to-severe disease. Recent findings In the past 5 years, four immunomodulators have been approved for the treatment of atopic dermatitis in children. These include dupilumab, ruxolitinib, upadacitinib, and abrocitinib. The review summarizes the pivotal phase 3 trials of these medications. Summary The newer immunomodulators have transformed the treatment of atopic dermatitis, particularly in patients with moderate-to-severe disease. Dupilumab targets IL-4 and IL-13, which are the main causes of allergic inflammation, resulting in great efficacy and few side effects. Upadacitinib and abrocitinib are alternative systemic medications for adolescents who have failed or are unable to tolerate dupilumab. Ruxolitinib cream is the latest addition to the current topical therapy. It is indicated for children 12 years and older with mild-to-moderate atopic dermatitis. Further studies are needed to confirm its safety and efficacy for younger children and for patients with more severe disease.

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“…The study included almost 3.4 million patients. The absolute risk of any cancer upon TCI exposure was similar to that of the control (absolute risk 4.70 per 1000 with TCI vs. 4.56 per 1000 without), suggesting that TCI is safe [ 62 ]. There was no impact of topical PIM use on T and B cell function or vaccination response [ 14 ].…”

Section: Role Of Pimecrolimus In the Management Of Ad In Infantsmentioning

confidence: 99%

Pimecrolimus for the Treatment of Atopic Dermatitis in Infants: An Asian Perspective

Chu

Yao

Shih

et al. 2023

Dermatol Ther (Heidelb)

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Atopic dermatitis (AD) is a common chronic, multisystem inflammatory skin disease in pediatric patients. There has been an increase in the incidence of AD in the pediatric population of the Asia–Pacific region. Studies have shown that genetic, epigenetic, environmental and cultural factors may lead to differences in the clinical manifestation and prevalence of AD between races. Early treatment of AD is necessary to prevent the atopic march leading to comorbidities such as asthma and allergic rhinitis. Topical corticosteroids (TCS) are used as first-line therapy for the treatment of AD, but their long-term usage poses a risk to the patient’s health. Pimecrolimus (1%) is a topical calcineurin inhibitor (TCI) that is indicated for the treatment of mild to moderate AD. Pimecrolimus has no apparent increase in adverse events compared to TCS, and it causes less of a burning sensation than tacrolimus. The safety and efficacy of pimecrolimus has been established through various clinical trials; yet, in many Asian countries, the use of pimecrolimus in infants is still restricted due to safety concerns. Based on the available evidence, the expert panel recommends pimecrolimus in infants between 3 months and 2 years of age in the Asian population.

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Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis

Cited by 28 publications

References 138 publications

A guide and pragmatic considerations for applying GRADE to network meta-analysis

A guide and pragmatic considerations for applying GRADE to network meta-analysis

Recent advances in immunomodulators for atopic dermatitis

Pimecrolimus for the Treatment of Atopic Dermatitis in Infants: An Asian Perspective

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