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

Lax, Stephanie J; Van Vogt, Eleanor; Candy, Bridget; Steele, Lloyd; Reynolds, Clare; Stuart, Beth; Parker, Roses; Axon, Emma; Roberts, Amanda; Doyle, Megan; Chu, Derek K; Futamura, Masaki; Santer, Miriam; Williams, Hywel C; Cro, Suzie; Drucker, Aaron M; Boyle, Robert J

Abstract

BackgroundEczema (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.ObjectivesTo compare and rank the efficacy and safety of topical anti-inflammatory treatments for people with eczema using a network meta-analysis.Search methodsWe 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 criteriaWe 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 analysisWe 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 resultsWe 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 Authors' conclusionsPotent TCS, JAK inhibitors and tacrolimus 0.1% were consistently ranked as amongst the most effective topical anti-inflammatory treatments for eczema and PDE-4 inhibitors as amongst the least effective. Mild TCS and tapinarof 1% were ranked amongst the least effective treatments in three of five efficacy networks. TCI and crisaborole 2% were ranked most likely to cause local application-site reactions and TCS least likely. We found no evidence for increased skin thinning with short-term TCS but an increase with longer-term TCS.

Citation

Lax, S. J., Van Vogt, E., Candy, B., Steele, L., Reynolds, C., Stuart, B., Parker, R., Axon, E., Roberts, A., Doyle, M., Chu, D. K., Futamura, M., Santer, M., Williams, H. C., Cro, S., Drucker, A. M., & Boyle, R. J. (2024). Topical anti-inflammatory treatments for eczema: network meta-analysis. Cochrane Database of Systematic Reviews, 2024(8), Article CD015064. https://doi.org/10.1002/14651858.CD015064.pub2

• Journal Article Type: Article
• Acceptance Date: Jun 24, 2024
• Online Publication Date: Aug 6, 2024
• Publication Date: Aug 6, 2024
• Deposit Date: Jul 19, 2024
• Publicly Available Date: Aug 7, 2025
• Journal: Cochrane Database of Systematic Reviews
• Electronic ISSN: 1469-493X
• Publisher: Cochrane Collaboration
• Peer Reviewed: Peer Reviewed
• Volume: 2024
• Issue: 8
• Article Number: CD015064
• DOI: https://doi.org/10.1002/14651858.CD015064.pub2
• Keywords: Humans, Eczema, Adrenal Cortex Hormones, Anti-Inflammatory Agents, Emollients, Administration, Topical, Quality of Life, Adult, Child, Female, Randomized Controlled Trials as Topic, Network Meta-Analysis, Bias
• Public URL: https://nottingham-repository.worktribe.com/output/37318058
• Publisher URL: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015064.pub2/full
• PMID: 39105474