Topical calcineurin inhibitors in atopic dermatitis: A systematic review and meta-analysis

El-Batawy, Mohammad Maged. Y.; Bosseila, Manal; Mashaly, Heba M.; Hafez, Vanessa Suzan G.A.

doi:10.1016/j.jdermsci.2009.02.002

Cited by 101 publications

(77 citation statements)

References 34 publications

(32 reference statements)

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“…Since 2000, 15 systematic reviews [79][80][81][82][83][84][85][86][87][88][89][90][91][92][93] and three guidelines 41, 42,94 have been published on the use of topical corticosteroids and/or topical calcineurin inhibitors. Two reviews have assessed occlusive therapy.…”

Section: Introductionmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Introductionmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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“…Такая стратегия более тщательно иссле-дована на примере топического ингибитора кальцинев-рина такролимуса [7,10].…”

Section: лечение обостренийunclassified

Atopic Dermatitis: New Targets of Therapy

Мачарадзе¹

2014

Vopr. sovr. pediatr.

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Российский университет дружбы народов, Москва, Российская ФедерацияЛечение атопического дерматита (АтД) Атопическим дерматитом (АтД) страдает 10-20% детского населения. Это один из наиболее распростра-ненных дерматитов, с которым обычно сталкиваются педиатры: в 50-95% случаев симптомы развиваются у детей в возрасте до 5 лет [1,2]. Прогноз болезни в основном благоприятный: приблизительно у 75% детей с АтД отмечается спонтанная ремиссия забо-левания до подросткового периода; оставшиеся 25% в зрелом возрасте в качестве проявлений АтД чаще всего имеют экзему рук либо испытывают повторные обострения кожных симптомов.Этиология и патофизиологические особенности развития болезни до конца не выяснены, однако современные научные данные подтверждают уча-стие генетических, экологических, иммунных и других факторов риска в развитии АтД. Известно, что АтД чаще развивается у тех детей, чьи родители и близ-кие страдают атопическими заболеваниями, посколь-ку генетические факторы играют определенную роль в предрасположенности к нему. В последнее время наибольшее значение придают генам, кодирующим эпидермальные структурные белки и ключевые эле-менты иммунной системы. В частности, у 50% больных АтД обнаружена достоверная связь между заболева-нием и мутацией гена филаггрина, кодирующего струк-турные белки рогового слоя эпидермиса, которые помогают упрочить связь между кератиноцитами кожи [3]. Это способствует сохранению целостности кожного барьера. С дефектом гена также связана повышенная трансэпидермальная потеря воды. Эти и другие фак-торы приводят к сухости кожи, увеличению пенетра-ции аллергенов, бактерий, грибов и вирусов в кожу,

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“…[7][8][9] Protopic (Astellas Toyama Co., Ltd, Toyama, Japan), the commercially available topical ointment formulation of FK506, has been approved by the FDA for the treatment of AD with two concentrations: 0.1% (w/w) for adults over age 16 and 0.03% (w/w) for children over age 2. It has become an alternative treatment of AD and is indicated for use on the face and neck; 10 the efficacy of the 0.1% (w/w) FK506 ointment for AD is almost equivalent to that of a strong-class corticosteroid based on randomized controlled clinical trials, [11][12][13] and it was the preferred long-term treatment of AD to prevent disruption of the skin barrier.…”

Section: Introductionmentioning

confidence: 99%

“…Thereafter, the sensitized skin was challenged with 100 μL of 1.0% (w/v) DNCB solution on the back and 10 μL on the right ear on days 4,7,11,14,17,20,23,26, and 28, respectively.…”

mentioning

confidence: 99%

Tacrolimus nanoparticles based on chitosan combined with nicotinamide: enhancing percutaneous delivery and treatment efficacy for atopic dermatitis and reducing dose

Yu¹,

Wang²,

Wan³

et al. 2017

IJN

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Background Topical application of tacrolimus (FK506) was effective in the treatment of atopic dermatitis (AD); however, adverse effects frequently occurred with the increase of FK506 dose during long–term treatment. Objective The objective of this project was to develop a hybrid skin targeting system encapsulating FK506 based on nicotinamide (NIC) and chitosan nanoparticles (CS–NPs), ie, FK506–NIC–CS–NPs, which took advantages of both of NIC and CS–NPs to obtain the synergetic effects of percutaneous delivery and treatment efficacy enhancement along with dose reduction. Methods The formulation of FK506–NIC–CS–NPs was optimized and characterized. In vitro and in vivo skin permeation studies were performed. AD–like skin lesions were constructed with BALB/c mice by 1–chloro–2, 4–dinitrobenzene (DNCB)–induced, and FK506–NIC–CS–NPs containing different dose of FK506 were topically administered to treat AD–like skin lesions in comparison with Protopic. Results NIC was found to significantly increase the FK506 EE to 92.2% by CS–NPs. In comparison with commercial FK506 ointment (Protopic), in vitro and in vivo skin permeation studies demonstrated that NIC–CS–NPs system significantly enhanced FK506 permeation through and into the skin, and deposited more FK506 into the skin. The treatment efficacy on clinical symptoms, histological analysis, and molecular biology of the AD–mice demonstrated that NIC–CS–NPs with ~1/3 dose of FK506 of Protopic was superior to that of Protopic, and NIC–CS–NPs vehicle exhibited the adjuvant therapy and moderate anti–AD effects. Conclusion The system of NIC–CS–NPs enhances the permeability of FK506, plays an adjuvant role in anti-AD, reduces the dose of FK506 in treating AD, and is therefore a promising nanoscale system of FK506 for the effective treatment of AD.

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Topical calcineurin inhibitors in atopic dermatitis: A systematic review and meta-analysis

Cited by 101 publications

References 34 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

Atopic Dermatitis: New Targets of Therapy

Tacrolimus nanoparticles based on chitosan combined with nicotinamide: enhancing percutaneous delivery and treatment efficacy for atopic dermatitis and reducing dose

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