Systemic treatments for eczema: a network meta-analysis

Sawangjit, Ratree; Dilokthornsakul, Piyameth; Lloyd-Lavery, Antonia; Lai, Nai Ming; Dellavalle, R.; Chaiyakunapruk, Nathorn

doi:10.1002/14651858.cd013206.pub2

Cited by 27 publications

(20 citation statements)

References 198 publications

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“…The severity of AD was assessed by the Eczema Area and Severity Index (EASI), Scoring of Atopic Dermatitis index (SCORAD) [14,15]. 50% and 75% improvement of EASI (EASI50/EASI75) score, decreasing amplitude of EASI and SCORAD and the change of Dermatitis Control Tool (ADCT) from baseline to the date of discharge were involved to analyze the e cacy of STS.…”

Section: The Indicators Recorded In This Studymentioning

confidence: 99%

Sodium thiosulfate ameliorates atopic dermatitis symptoms via inhibiting inflammatory infiltration and restoring skin barrier function

Zeng

Wang#

Liu

et al. 2022

Preprint

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Background Atopic dermatitis (AD) is a common disease with a considerable impact on the affected individual’s quality of life and has limited treatment options. Sodium thiosulfate (STS) is a traditional medicine used in the rescue of cyanide poisoning, and some pruritus dermatosis. However, the exact efficacy and mechanism of its application with AD are not clear. Patients and Methods: We reviewed the records of patients with moderate to severe AD treated in the department of dermatology, the Third Xiangya Hospital, between January 2020 and July 2021. The change of Eczema Area and Severity Index (EASI), Scoring of Atopic Dermatitis index (SCORAD), Atopic Dermatitis Control Tool (ADCT), Patient-reported outcomes (PROs), skin barrier indexes and serum biochemical indicators were recorded. Results A total of 60 moderate to severe AD patients were enrolled, 20 in the STS 0.64g once daily + conventional therapy (STS QD) group, 20 in the STS 0.64g twice daily + conventional therapy (STS BID) group and 20 in the conventional therapy (control) group. Conventional therapy consisted of intravenous fluids of calcium, vitamin C and oral antihistamines rupatadine and bepotastine. Treatment with STS led to greater improvement with higher proportion of EASI50 and EASI75 and lower ADCT index compared to the control group. After treatment, greater improvement in PROs, skin barrier indexes were also observed in the STS treatment group than in the control group. To further study the underlying mechanism of STS, we analyzed the serum biochemical indicators. STS downregulated IgE by 4.12- and 7.26-folds (P = 0.0006 and P < 0.0001, respectively) and eosinophils by 2.24- and 5.28-folds (P = 0.0205 and P < 0.0001, respectively) in STS QD and STS BID group. In addition, STS downregulated interleukin-13(IL-13) by 2.86- and 3.16-folds (Both P < 0.0001) and interleukin-4 (IL-4) by 2.42- and 4.68-folds (Both P < 0.0001) in STS QD and STS BID group. Conclusion STS in combination with conventional therapy improves the signs and symptoms of AD by improving skin barrier function and downregulating concentrations of IgE, eosinophils and release of IL-4 and IL-13.

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Section: The Indicators Recorded In This Studymentioning

confidence: 99%

Sodium thiosulfate ameliorates atopic dermatitis symptoms via inhibiting inflammatory infiltration and restoring skin barrier function

Zeng

Wang#

Liu

et al. 2022

Preprint

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“…Moreover, infantile eczema obviously impairs infantile quality of life and potentially influence growth ( 4 , 5 ). Current treatments for eczema aim to relieve symptoms since there is no cure for it ( 6 , 7 ). General measures include the application of emollients and topical agents and avoidance of infections and trigger factors ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

The positive effect of mother-performed infant massage on infantile eczema and maternal mental state: A randomized controlled trial

Lin

Zhang

et al. 2023

Front. Public Health

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ObjectiveTo observe the influence of MPIM on infantile eczema, quality of life, growth and maternal mental state.MethodsThis trial was a randomized controlled study. Sixty-six full-term infants with eczema were randomly divided into eczema control group (EC group, n = 33) and eczema with MPIM group (EM group, n = 33), along with healthy full-term infants in the healthy control group (HC group, n = 31). The mothers in the EC group received the instruction of routine care, while the mothers in the EM group applied massage on the infants plus receiving the same instruction of the routine care. HC group received none of any specific intervention. Data were collected in the three groups at the baseline and at the end of 2- and 5-month intervention. Before and at the end of 2-month intervention, the following indexes were investigated in infants including the growth indexes, eczema area severity index (EASI), infantile dermatitis quality of life index (IDQOL). And the scores of self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were investigated in mothers at the same timepoints. At the end of 5-month intervention, the infants' growth and relapse condition of eczema were observed.ResultsOverall, 31 cases in HC group, 31 in EC group and 32 in EM group were included for data analysis. There were no significant differences in the indexes of infantile growth among the three groups (all P >0.05). The scores of EASI and IDQOL significantly lowered (both P < 0.001) in EC group following the instruction of routine care, along with reduced maternal scores of SAS and SDS (both P < 0.05). Compared with the EC group, the EM group showed significantly lower scores of EASI and IDQOL (both P < 0.001) and lower relapse rate (P < 0.01) in infants with eczema, along with significantly lower scores of SAS and SDS in mothers (both P < 0.01). Moreover, none of obvious adverse reaction was reported following MPIM, to which most of the mothers could adhere.ConclusionMPIM could effectively promote the remission of infantile eczema and reduce its relapse, along with relieving maternal anxiety and depression mood.Clinical trial registrationIdentifier: ChiCTR2200066246.

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“…Traditional antimetabolite immuno-modulators, such as azathioprine, mycophenolate mofetil, cyclosporine, and methotrexate, are often used off-label to control severe diseases (8,9,13,14). Dupilumab is the first therapy to be approved for moderate-to-severe AD that does not respond to topical therapies based on large, randomized, double-blind placebo-controlled clinical trials (10,(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). More approvals for novel systemic targeted therapies for AD are anticipated in the next few years, including biologics and small molecules such as Janus kinase (JAK) inhibitors (29).…”

Section: Introductionmentioning

confidence: 99%

Treatment Guidelines for Atopic Dermatitis Since the Approval of Dupilumab: A Systematic Review and Quality Appraisal Using AGREE-II

et al. 2022

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IntroductionSince its approval for adults with moderate-to-severe atopic dermatitis (AD) in 2017, dupilumab has been incorporated into clinical practice guidelines (CPGs). However, recommendations differ internationally, and the quality assessment of their development is unclear.ObjectiveWe aimed to systematically review and appraise the quality of CPGs for adult AD reported since 2017 and map the recommendations for dupilumab initiation relative to conventional systemic therapy (CST).Materials and MethodsA literature search was conducted in June 2020 in MEDLINE, EMBASE, SCOPUS, and CINAHL. Twelve CPGs were retrieved. Methodological quality was assessed using the validated Appraisal of Guidelines for Research & Evaluation II tool (AGREE-II). Recommendations were extracted and compared.ResultsAGREE-II median scores per domain of the CPGs were (%, r = range): scope/purpose, 78% (50–96); stakeholder involvement, 54% (28–85); rigor of development, 39% (21–63); clarity of presentation, 85% (69–100); applicability, 27% (6–51); and editorial independence, 76% (42–100). Neither met the threshold of 70% quality criteria for rigor of development nor the applicability domains. Three CPGs met the criteria for recommendation without modification. CPGs' approach to dupilumab initiation was as follows: second line, preferred over CST and nbUVB (n = 1/12 CPG); second line, equivalent to CST or nbUVB (n = 3/12 CPGs); third line, after nbUVB or CST (n = 5/12 CPGs); and fourth line after nbUVB and CST (n = 2/12). No consensus was reached for n = 1/12 CPG.Conclusion and RelevanceDupilumab is now incorporated into CPGs for adult AD. These CPGs exhibited good quality in scope/purpose, clarity, and editorial independence domains. However, none met AGREE-II criteria for methodological rigor/applicability. Gaps were found in mechanisms for updates, facilitators/barriers, resource implications, and stakeholder involvement. Only n = 3/12 CPGs met quality criteria for recommendation without modifications. Of these, two favored a conservative sequential approach for the initiation of dupilumab relative to CST, while one did not reach consensus. Our findings highlight divergent recommendations AD treatment, underlining a need to incorporate quality criteria into future guideline development.

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Systemic treatments for eczema: a network meta-analysis

Cited by 27 publications

References 198 publications

Sodium thiosulfate ameliorates atopic dermatitis symptoms via inhibiting inflammatory infiltration and restoring skin barrier function

Sodium thiosulfate ameliorates atopic dermatitis symptoms via inhibiting inflammatory infiltration and restoring skin barrier function

The positive effect of mother-performed infant massage on infantile eczema and maternal mental state: A randomized controlled trial

Treatment Guidelines for Atopic Dermatitis Since the Approval of Dupilumab: A Systematic Review and Quality Appraisal Using AGREE-II

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