Anne Mason1, James Mason2, Michael Cork3, Helen Hancock2, Gordon Dooley4. 1. Center for Health Economics, University of York, York, United Kingdom. Electronic address: anne.mason@york.ac.uk. 2. School of Medicine, Pharmacy, and Health, Durham University, Stockton-on-Tees, United Kingdom. 3. Academic Unit of Dermatology Research, University of Sheffield Medical School, Sheffield, United Kingdom. 4. Metaxis Ltd, Curbridge, United Kingdom.
Abstract
BACKGROUND: Chronic plaque psoriasis is the most common type of psoriasis and is characterized by redness, thickness, and scaling. First-line management is with topical treatments. OBJECTIVE: We sought to undertake a Cochrane review of topical treatments for chronic plaque psoriasis. METHODS: We systematically searched major databases for randomized controlled trials. Trials reported improvement using a range of related measures; standardized, pooled findings were translated onto a 6-point improvement scale. RESULTS: The review included 177 randomized controlled trials with 34,808 participants, including 26 trials of scalp psoriasis and 6 trials of inverse and/or facial psoriasis. Typical trial duration was 3 to 8 weeks. When compared with placebo (emollient base), the average improvement for vitamin-D analogues and potent corticosteroids was approximately 1 point, dithranol 1.2 points, very potent corticosteroids 1.8 points, and combined vitamin-D analogue plus steroid 1.4 points once daily and 2.2 points twice daily. However, these are indicative benefits drawn from heterogeneous trial findings. Corticosteroids were more effective than vitamin D for treating psoriasis of the scalp. For both body and scalp psoriasis, potent corticosteroids were less likely than vitamin D to cause skin irritation. LIMITATIONS: Reporting of benefits, adverse effects, and safety assessment methods was often inadequate. In many comparisons, heterogeneity made the size of treatment benefit uncertain. CONCLUSIONS: Corticosteroids are as effective as vitamin-D analogues and cause less skin irritation. However, further research is needed to inform long-term maintenance treatment and provide appropriate safety data.
BACKGROUND: Chronic plaque psoriasis is the most common type of psoriasis and is characterized by redness, thickness, and scaling. First-line management is with topical treatments. OBJECTIVE: We sought to undertake a Cochrane review of topical treatments for chronic plaque psoriasis. METHODS: We systematically searched major databases for randomized controlled trials. Trials reported improvement using a range of related measures; standardized, pooled findings were translated onto a 6-point improvement scale. RESULTS: The review included 177 randomized controlled trials with 34,808 participants, including 26 trials of scalp psoriasis and 6 trials of inverse and/or facial psoriasis. Typical trial duration was 3 to 8 weeks. When compared with placebo (emollient base), the average improvement for vitamin-D analogues and potent corticosteroids was approximately 1 point, dithranol 1.2 points, very potent corticosteroids 1.8 points, and combined vitamin-D analogue plus steroid 1.4 points once daily and 2.2 points twice daily. However, these are indicative benefits drawn from heterogeneous trial findings. Corticosteroids were more effective than vitamin D for treating psoriasis of the scalp. For both body and scalp psoriasis, potent corticosteroids were less likely than vitamin D to cause skin irritation. LIMITATIONS: Reporting of benefits, adverse effects, and safety assessment methods was often inadequate. In many comparisons, heterogeneity made the size of treatment benefit uncertain. CONCLUSIONS: Corticosteroids are as effective as vitamin-D analogues and cause less skin irritation. However, further research is needed to inform long-term maintenance treatment and provide appropriate safety data.
Keywords:
BD; CI; IAGI; Investigator Assessment of Global Improvement; OD; SD; SMD; confidence interval; drug administration; drug safety; once daily; psoriasis; review; standard deviation; standardized mean difference; topical; treatment outcome; twice daily
Authors: Roger Bouillon; Claudio Marcocci; Geert Carmeliet; Daniel Bikle; John H White; Bess Dawson-Hughes; Paul Lips; Craig F Munns; Marise Lazaretti-Castro; Andrea Giustina; John Bilezikian Journal: Endocr Rev Date: 2019-08-01 Impact factor: 19.871
Authors: William R Swindell; Mrinal K Sarkar; Philip E Stuart; John J Voorhees; James T Elder; Andrew Johnston; Johann E Gudjonsson Journal: Clin Transl Med Date: 2015-03-19
Authors: Maria Quaranta; Stefanie Eyerich; Bettina Knapp; Francesca Nasorri; Claudia Scarponi; Martina Mattii; Natalie Garzorz; Anna T Harlfinger; Teresa Jaeger; Martine Grosber; Davide Pennino; Martin Mempel; Christina Schnopp; Fabian J Theis; Cristina Albanesi; Andrea Cavani; Carsten B Schmidt-Weber; Johannes Ring; Kilian Eyerich Journal: PLoS One Date: 2014-07-24 Impact factor: 3.240