Topical anti-inflammatory treatments for eczema: network meta-analysis

Steele, Lloyd; Stuart, Beth; Axon, Emma; Harvey, Jane; Roberts, Amanda; Santer, Miriam; Williams, Hywel C; Drucker, Aaron M.; Boyle, Robert

doi:10.1002/14651858.cd015064

Cited by 3 publications

(3 citation statements)

References 76 publications

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“…In addition, we checked for RCTs included in two Cochrane reviews on topical treatments for eczema being conducted by the same authorship. 12 , 14 The database search from the Cochrane review “Topical anti‐inflammatory treatments for eczema: network meta‐analysis” was updated on 13/1/2023 with the clinical trial registry search conducted on 19/1/2023. Included studies within these reviews and within this review were hand searched to identify further trials.…”

Section: Methodsmentioning

confidence: 99%

The long‐term safety of topical corticosteroids in atopic dermatitis: A systematic review

Harvey

Lowe

Santer

et al. 2023

Skin Health and Disease

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BackgroundTopical corticosteroids (TCS) are a first‐line treatment for eczema, but there are concerns about their safety when used long‐term.ObjectivesTo systematically review adverse effects associated with longer‐term use of TCS for eczema.MethodsRandomised controlled trials (RCTs), cohort and case‐control studies reporting adverse effects of TCS (comparators: no TCS treatment, other topicals) in patients with eczema were identified. Included studies had greater than one year of follow‐up, minimum cohort size of 50 participants, or minimum 50 per arm for RCTs. Evidence was GRADE‐assessed. Prospero registration CRD42021286413.ResultsWe found seven studies (two randomised, five observational); two RCTs (n = 2570, including 1288 receiving TCS), two cohort (all received TCS n = 148) and three case‐control studies (cases n = 10 322, controls n = 12 201). Evidence from two RCTS (n = 2570, children, three and five years' duration) comparing TCS to topical calcineurin inhibitors found intermittent TCS use probably results in little to no difference in risk of growth abnormalities, non‐skin infections, impaired vaccine response and lymphoma/non lymphoma malignancies. The five‐year RCT reported only one episode of skin atrophy (n = 1213 TCS arm; mild/moderate potency), suggesting TCS use probably results in little to no difference in skin thinning when used intermittently to treat flares. No cases of clinical adrenal insufficiency were reported in 75 patients using mild/moderate TCS in the three‐year RCT. Small associations between TCS and type‐2 diabetes and lymphoma were identified in two case‐control studies compared to no TCS, but the evidence is very uncertain. No long‐term studies concerning topical steroid withdrawal or eye problems were identified.ConclusionThis review provides some reassuring data on growth and skin thinning when TCS are used intermittently for up to 5 years, but many knowledge gaps remain.

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Section: Methodsmentioning

confidence: 99%

The long‐term safety of topical corticosteroids in atopic dermatitis: A systematic review

Harvey

Lowe

Santer

et al. 2023

Skin Health and Disease

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“…In any case, as Landis and coauthors reported data aligning with the established Harmonising Outcome Measures for Eczema core outcome set, 4 we hope to include brepocitinib cream in our proposed network meta-analyses of the comparative efficacy and safety of topical anti-inflammatory treatments for eczema. 5 We look forward to well-powered phase III studies with longer treatment duration, active comparators and cost-benefit analyses, to determine whether brepocitinib will be a viable, accessible treatment option for people with mild-to-moderate eczema treated in community settings.…”

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confidence: 99%

“…As of now (22 August 2022), a search of http://clinicaltrials.gov did not reveal any information posted about what larger, phase III studies for brepocitinib cream for eczema may look like. In any case, as Landis and coauthors reported data aligning with the established Harmonising Outcome Measures for Eczema core outcome set, 4 we hope to include brepocitinib cream in our proposed network meta‐analyses of the comparative efficacy and safety of topical anti‐inflammatory treatments for eczema 5 …”

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How will brepocitinib cream compare with established treatments for mild-to-moderate eczema?

Drucker

2022

British Journal of Dermatology

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Topical anti-inflammatory treatments for eczema: network meta-analysis

Lax,

Van Vogt,

Candy

et al. 2024

Cochrane Database of Systematic Reviews

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Background Eczema (atopic dermatitis) is the most burdensome skin condition worldwide and cannot currently be prevented or cured. Topical anti‐inflammatory treatments are used to control eczema symptoms, but there is uncertainty about the relative effectiveness and safety of different topical anti‐inflammatory treatments. Objectives To compare and rank the efficacy and safety of topical anti‐inflammatory treatments for people with eczema using a network meta‐analysis. Search methods We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries on 29 June 2023, and checked the reference lists of included studies. Selection criteria We included within‐participant or between‐participant randomised controlled trials (RCTs) in people of any age with eczema of any severity, but excluded trials in clinically infected eczema, seborrhoeic eczema, contact eczema, or hand eczema. We included topical anti‐inflammatory treatments used for at least one week, compared with another anti‐inflammatory treatment, no treatment, or vehicle/placebo. Vehicle is a 'carrier system' for an active pharmaceutical substance, which may also be used on its own as an emollient for dry skin. We excluded trials of topical antibiotics used alone, complementary therapies, emollients used alone, phototherapy, wet wraps, and systemic treatments. Data collection and analysis We used standard Cochrane methods. Primary outcomes were patient‐reported eczema symptoms, clinician‐reported eczema signs and investigator global assessment. Secondary outcomes were health‐related quality of life, long‐term control of eczema, withdrawal from treatment/study, and local adverse effects (application‐site reactions, pigmentation changes and skin thinning/atrophy were identified as important concerns through patient and public involvement). We used CINeMA to quantify our confidence in the evidence for each outcome. Main results We included 291 studies involving 45,846 participants with the full spectrum of eczema severity, mainly conducted in high‐income countries in secondary care settings. Most studies included adults, with only 31 studies limited to children aged < 12 years. Studies usually included male and female participants, multiple ethnic groups but predominantly white populations. Most studies were industry‐funded (68%) or did not report their funding sources/details. Treatment duration and trial participation were a median of 21 and 28 days (ranging from 7 days to 5 years), respectively. Interventions used were topical corticosteroids (TCS) (172), topical calcineurin inhibitors (TCI) (134), phosphodiesterase‐4 (PDE‐4) inhibitors (55), janus kinase (JAK) inhibitors (30), aryl hydrocarbon receptor activators (10), or other topical agents (21). Comparators included vehicle (170) or other anti‐inflammatory treatments. The risk of bias was high in 2...

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Topical anti-inflammatory treatments for eczema: network meta-analysis

Cited by 3 publications

References 76 publications

The long‐term safety of topical corticosteroids in atopic dermatitis: A systematic review

The long‐term safety of topical corticosteroids in atopic dermatitis: A systematic review

How will brepocitinib cream compare with established treatments for mild-to-moderate eczema?

Topical anti-inflammatory treatments for eczema: network meta-analysis

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