scholarly journals Expert Perspectives on Key Parameters that Impact Interpretation of Randomized Clinical Trials in Moderate-to-Severe Atopic Dermatitis

Author(s):  
Jonathan I. Silverberg ◽  
Eric L. Simpson ◽  
April W. Armstrong ◽  
Marjolein S. de Bruin-Weller ◽  
Alan D. Irvine ◽  
...  
2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Heidrun Männle ◽  
Karsten Münstedt

Context: Bee products are frequently suggested as possible treatments for dermatological problems by protagonists of apitherapy, which is a discipline within the field of complementary and alternative medicine. Unfortunately, apitherapists do not support their health claims. This review was to identify potential uses of bee products in the field of dermatology. Evidence Acquisition: Randomized and non-randomized clinical trials, case-control studies, systematic reviews, and meta-analyses on the topics were identified using various search engines. Results: Evidence suggests that bee products may be a reasonable treatment option for wound infections, burns, radiodermatitis, infections with herpes viruses, atopic dermatitis, rosacea, scars, cutaneous warts, acne, psoriasis, facial wrinkles, and intertrigo. Conclusions: There are several applications for bee products in the field of dermatology, for instance treatment of wound infections with honey and herpes infections with propolis.


Life ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 927
Author(s):  
José-Juan Pereyra-Rodriguez ◽  
Sara Alcantara-Luna ◽  
Javier Domínguez-Cruz ◽  
Manuel Galán-Gutiérrez ◽  
Ricardo Ruiz-Villaverde ◽  
...  

Background: Some Network Meta-analysis (NMA) has been published regarding atopic dermatitis (AD). These studies have considered drugs under investigation both in monotheraphy or in combination with topical corticosteroids, as well as systemic immunosuppressant therapies. The objective of this study is to evaluate the efficacy and safety of biological agents and small molecules in AD. Methods: A systematic review and NMA of biologics agents and small molecules in AD was performed. A literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for clinical trials and systematic reviews between January 2000 and 19 December 2020. Only randomized clinical trials (RCTs) were included. It was limited to English language and adult human subjects. Two networks were evaluated: monotherapy and combination with TCS. The two primary outcomes were Eczema Area and Severity Index (EASI) 75 and EASI 90 change from baseline to week 12–16, depending on source study cut-off. The Cochrane’s Risk of Bias tool 2011 update was used to analyze the risk of bias, focused on the primary objectives. Results: 30 RCTs (included in 26 publications) were included in the systematic review. Finally, 23 RCTs were included in the quantitative analysis (14 RCTs including 3582 patients in monotherapy; and 9 RCTs including 3686 patients with TCS). In monotherapy, a higher percentage of patients achieving EASI-75 was obtained with Upadacitinib 30 mg [OR: 18.90 (13.94; 25.62)] followed by Abrocitinib 200 mg [OR = 11.26 (7.02; 18.05)] and Upadacitinib 15 mg [OR: 10.89 (8.13; 14.59)]. These results were also observed in studies where the use of topical corticosteroid (TCS) was allowed (OR Upadacitinib 30 mg = 9.43; OR Abrocitinib 200 mg = 6.12; OR Upadacitinib 15 mg = 5.20). Regarding IGA, the percentage of patients achieving IGA0/1 was higher with both doses of Upadacitinib 30 mg [OR: 19.13 (13.14; 27.85)] and 15 mg [OR = 10.95 (7.52; 15.94). In studies where the use of TCS were allowed, however, the dose of Abrocitinib 200 mg [OR = 6.10 (3.94; 9.44)] showed higher efficacy than Upadacitinib 15 mg [OR = 5.47 (3.57; 8.41)]. Regarding safety, the drugs with the highest probability of presenting adverse effects were the Janus kinases (JAK) inhibitors, Upadacitinib and Abrocitinib in monotherapy and Baricitinib in combination with TCS. Discussion: Some risks of bias have been found, which must be taken into account when interpreting the results. The funnel plot shows a possible publication bias that may underestimate the efficacy of drugs. Upadacitinib and Abrocitinib are the drugs with the highest efficacy, both in monotherapy and in association with TCS. However, they were also those associated with the highest risk of adverse effects, showing monoclonal antibodies better safety profile. Limitations: We have included molecules still in the development phase as well studies completed and presented at conferences and with data available in Trialsgov® but not published yet. Several molecules’ development had included a small number of patients from 12 to 17 years of age, without being able to differentiate the results from the adult population. Other: Founding: None. PROSPERO database registration number CRD42021225793.


2020 ◽  
Vol 156 (11) ◽  
pp. 1240
Author(s):  
Megan Lam ◽  
Jie Wei Zhu ◽  
Talha Maqbool ◽  
Gaelen Adam ◽  
Mina Tadrous ◽  
...  

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