Comparison of Cyclosporin and UVAB Phototherapy for Intermittent One-year Treatment of Atopic Dermatitis

Abstract

Although cyclosporin is effective for the treatment of severe atopic dermatitis, phototherapy is the standard second-line treatment for this disease. An open, randomized, controlled, parallel-group study was conducted to compare the efficacy, influence on quality of life and safety of cyclosporin and UVAB phototherapy during 1 year of intermittent treatment of atopic dermatitis in adult patients. The main endpoints of the study were the number of days in remission and the influence on quality of life. Seventy-two patients were treated, 36 in each group. Cyclosporin produced significantly more days in remission than UVAB phototherapy during the 1-year study period. At the end of the study no difference between the 2 groups was noted in terms of quality of life. A significant increase in serum creatinine occurred in 2 patients and 7 patients developed mild or moderate hypertension during cyclosporin treatment. It can be concluded that intermittent cyclosporin seems to be more effective than UVAB and is reasonably safe for the treatment of atopic dermatitis over a 1-year treatment period.

Poor Reporting of Quality of Life Outcomes in Dermatology Randomized Controlled Clinical Trials

“…The remaining 67 articles satisfied our criteria [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73]. Sixteen concerned atopic dermatitis [7, 13, 14, 18,20,21,22, 26, 29, 31, 42, 46, 56, 66, 67, 70], 1 chronic eczema of the hands [9], 25 psoriasis [10, 17, 27, 30, 33,35,36,37,38,39,...…”

“…In 7% (5/67) of the papers, results were presented as means ± SD of the overall scores and for each dimension for each group studied [7, 9, 11, 15, 52]; in 24% (16/67) of the articles, only the overall scores were given [10, 14, 16, 25, 27, 31, 43, 44, 46, 48,54,55,56, 67, 71, 73]; in 39% (26/67) of the articles, only the scores of the difference (before and after treatment), but not overall scores, were provided [8, 17,19,20,21,22,23,24, 29, 30, 33, 35, 37,39,40,41, 47, 49, 53, 57, 60, 62, 63, 65, 70, 72]. The percentage of improvement of the overall score was reported in 15% (10/67) of the studies [18, 26, 36, 38, 42, 51, 58, 59, 64, 68], and 10 gave unclear or no numerical values [12, 13, 28, 32, 34, 45, 50, 61, 66, 69].…”

“…the number of dimensions and their contents, such as the number of items per dimension, and the minimal and maximal scores [9, 15, 20, 33, 39, 40, 43, 44, 51, 57, 58, 65, 69]. Only the name of the questionnaire was given in 16 others [12, 18, 19, 21, 25, 31, 32, 38, 45, 46, 53, 54, 61, 64, 66, 71].…”

“…No minimal QOL impairment at inclusion was ever mentioned. Regardless of whether QOL was a primary or secondary endpoint, 5% (3/67) of articles included a hypothesis of a QOL score change with calculation of the number of subjects needed to obtain the desired statistical power [14, 20, 40]. …”

What Is Meant by a “Flare” in Atopic Dermatitis?

“…Four groups of investigators used varying levels of change in the Scoring Atopic Dermatitis (SCORAD) score to define disease exacerbation. [8][9][10][11]17,18 Other investigators have used the ThreeItem Severity (TIS) score, the total body disease activity score, the IGA score, and the modified Costa scoring system (details are given in the Table). 7,[12][13][14][19][20][21] …”