Comparative Efficacy of Pharmacological and Nonpharmacological Interventions for Acne Vulgaris: A Network Meta-Analysis

Abstract

Acne has several effects on physical symptoms, but the main impacts are on the quality of life, which can be improved by treatment. There are several acne treatments but less evidence comparing their relative efficacy. Thus, we assessed the comparative efficacy of pharmacological and nonpharmacological interventions for acne. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to April 2019, to include randomized controlled trials for acne that compared topical antibiotics (TA), benzoyl peroxide (BPO), topical retinoids (TR), oral antibiotics (OA), lasers, light devices including LED device (LED), photodynamic therapy (PDT), and intense pulsed light, chemical peels (CP), miscellaneous therapies or complementary and alternative medicine (MTCAM), or their combinations. We performed Bayesian network meta-analysis with random effects for all treatments compared with placebo and each other. Mean differences (MDs) of lesions count and risk ratios of adverse events with their 95% credible intervals (CrIs) were calculated, and all interventions were ranked by the Surface Under the Cumulative Ranking (SUCRA) values. Additional frequentist additive network meta-analysis was performed to detect the robustness of results and potential interaction effects. Sensitivity analyses were carried out with different priors, and metaregression was to adjust for nine potential effect modifiers. In the result, seventy-three randomized controlled trials (27,745 patients with mild to moderate acne), comparing 30 grouped intervention categories, were included with low to moderate risk of bias. For adverse effects, OA had more risk in combination treatment with others. For noninflammatory lesions reduction, seventeen interventions had significant differences comparing with placebo and three interventions (TR+BPO: MD = −21.89, 95%CrI [−28.97, −14.76]; TR+BPO+MTCAM: −22.48 [−34.13, −10.70]; TA+BPO+CP: −20.63 [−33.97, −7.13]) were superior to others with 94, 94, and 91% SUCRA values, respectively. For inflammatory lesions reduction, nineteen interventions were significantly better than placebo, and three interventions (TR+BPO: MD = −12.13, 95%CrI [−18.41, −5.80]; TR+BPO+MTCAM: −13.21 [−.39, −3.04]; LED: −11.30 [−18.34, −4.42]) were superior to others (SUCRA: 81, 81, and 77%, respectively). In summary of noninflammatory and inflammatory lesions results, TR+BPO and TA+BPO were the best options compared to others. The frequentist model showed similar results as above. In summary, current evidence supports the suggestion that TR+BPO and TA+BPO are the best options for mild to moderate acne. LED is another option for inflammatory lesions when drug resistance occurs. All the combinations involved with OA showed more risk of adverse events than others. However, the evidence of this study should be cautiously used due to the limitations.

Computational evidence for nitro derivatives of quinoline and quinoline N-oxide as low-cost alternative for the treatment of SARS-CoV-2 infection

“…5 A, the N-4-Q compound performed hydrogen bond interaction with Cys44 (2.78 Å) and hydrophobic interactions with Thr45, Ser46, Met49, Gln189, His41, Val42, Met165, Glu166, His164, Cys145, His163, Ser144, Gly143, respectively. These interactions are essential in inhibiting the enzymatic activity of M pro and are in accordance with some other studies 51 – 53 , as well as the docking results of this work. By analyzing the graph of hydrogen interactions (see Figure S4 ), we found that the compound N-4-Q performed up to three hydrogen bond type interactions.…”

“…5 B. According to Zhang and coworkers 53 , in the catalytic site, the residues Glu166, His41, and Gys145, respectively, are key species of the target protease. Thus, the interaction of these amino acids with inhibitors is essential for blocking the enzymatic activity of M pro .…”

Comparative Efficacy and Acceptability of Anti-inflammatory Agents on Major Depressive Disorder: A Network Meta-Analysis

“…A convergence diagnostic plot was constructed using the Brooks-Gelman-Rubin statistics, with 50,000 adaptation iterations for obtaining convergence and 100,000 simulation iterations (thinning factor = 10) for generating the outputs ( Gelman and Rubin, 1992 ; BROOKS.and GELMAN, 1998 ). The analysis was conducted under a random effect model to explain the between-study heterogeneity such as clinical heterogeneity and produce more generalizable results ( Shi et al, 2020 ). Residual deviance represents the contribution of 1 data point for each study arm in a well-fitting model.…”

Human cell receptors: potential drug targets to combat COVID-19

“…The in silico computational studies identified compounds such as Itacitinib, Oberadiol, Telcagepant, Vidupiprant, Pilaralisib, Poziotinib, Fostamatinib, CL-275838, Ziprasidone, Leucal/Folinic Acid, and ITX506 (Liu et al 2020a ), inhibit both SARS-CoV and SARS-CoV-2 by targeting M pro at Cys145. Hepatitis C virus protease inhibitors, Boceprevir and Telaprevir (Ma et al 2020a ), calpain inhibitors II and XII, GC-376 (Ma et al 2020a ), and α-ketoamide inhibitors (Zhang et al 2020a ) effectively block the activity of M pro to inhibit SARS-CoV-2. In contrast, some M pro inhibitors were shown to be ineffective for SARS-CoV and SARS-CoV-2.…”