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Treatment of atopic dermatitis and impact on quality of life: a review with emphasis on topical non-corticosteroids |
Schiffner R, Schiffner-Rohe J, Landthaler M, Stolz W |
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CRD summary This review assessed the impact on quality of life of different topically applicable alternatives to corticosteroids for the treatment of atopic dermatitis (AD). The authors concluded that there are a clear lack of randomised controlled studies that have compared different treatments and their impact on quality of life in participants with AD. Although a number of biases might have been introduced into the review, these conclusions appear appropriate.
Authors' objectives To assess the impact on quality of life (QoL) for topically applicable alternatives to corticosteroids in atopic dermatitis (AD).
Searching MEDLINE, EMBASE, Ingenta, SciSearch and BIOSIS Previews were searched until October 2002; no search terms were reported. In addition, abstracts and poster presentations from the 10th and 11th Congress of the European Academy of Dermatology and Venereology, and the 20th World Congress of Dermatology were handsearched. It was not stated whether any language restrictions were applied.
Study selection Study designs of evaluations included in the reviewNo inclusion criteria were stated in relation to the study design. Both randomised controlled trials (RCTs) and uncontrolled studies were included in the review.
Specific interventions included in the reviewStudies that assessed topically applied treatments were eligible for inclusion. The specific treatments assessed were corticosteroids, tacrolimus/pimecrolimus, ultraviolet (UV) UVA/UVB combinations, UVB narrowband, and cyclosporin. The length of treatment ranged from 6 weeks to 12 months.
Participants included in the reviewPatients with AD were eligible for inclusion. The studies included adults, children and infants, with an age range from 0 to 42 years.
Outcomes assessed in the reviewStudies that reported a QoL outcome measure were eligible for inclusion. The specific scales used were the Eczema Area and Severity Index, Severity Scoring of Atopic Dermatitis, Childrens Dermatology Life Quality Index, Dermatology Life Quality Index, Eczema Disability Index, Parent Index of Quality of Life-Atopic Eczema, the Six Area Total Body Severity Assessment, Chronic Skin Disease Questionnaire, Freiburg Life Quality Assessment Questionnaire and the United Kingdom Sickness Impact Profile.
How were decisions on the relevance of primary studies made?The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.
Assessment of study quality The quality of the primary studies was assessed according to the type of measurement scale (global, disease-specific), number of measurements used, validity criteria for QoL measurement, QoL assessment post study, QoL assessment after follow-up, correlation between objective and subjective measures, and the use of health state utilities. The validity criteria for QoL measurement were based on literature references, relevance of study aim, age group, validation in used language, sensitivity to change in QoL, and correlation between time period of questionnaire and treatment. The authors did not state how the papers were assessed for quality, or how many reviewers performed the quality assessment.
Data extraction The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction. Data were extracted on study demographics, intervention, type and age of the participants, objective clinical measurement, type of rating scale, whether there was a correlation between the objective and subjective measurements, and the change in subjective measurement after treatment and follow-up.
Methods of synthesis How were the studies combined?The studies were combined in a narrative.
How were differences between studies investigated?Differences between the studies were discussed in relation to the different interventions assessed, the different rating scales used, and the differences in the patient populations that had been assessed.
Results of the review Twenty studies were included: 6 RCTs (n=1,649) and 14 uncontrolled studies (n=545).
All the different interventions showed a clear improvement in QoL after treatment. However, a comparison between the studies was not undertaken because of the different scales, different participant inclusion criteria, treatment schedules and the presentation of results.
Authors' conclusions There was a clear lack of RCTs that evaluated different active treatment modalities and their impact on QoL in participants with AD.
CRD commentary The review question was reasonably clear in terms of the participants, interventions and study designs, although these were not explicitly stated in the paper. Several sources were searched for relevant studies, but it was unclear whether any language restrictions were applied. Potentially relevant studies might, therefore, have been missed. The review methods were not reported, thus it is not known any whether efforts were made to minimise bias and errors. The quality of the studies was assessed, and aspects of this were described in a tabular format. The results of the review were appropriately combined in a narrative and differences between the studies were discussed, both in relation to the different interventions and the quality of the studies. Overall, although some biases might have been introduced into the review, the authors' conclusions appear appropriate.
Implications of the review for practice and research Practice: The authors did not state any implications for practice.
Research: The authors stated that there was a lack of studies comparing different treatment modalities and their impact on QoL in AD. Future research should therefore attempt to further assess this issue.
Bibliographic details Schiffner R, Schiffner-Rohe J, Landthaler M, Stolz W. Treatment of atopic dermatitis and impact on quality of life: a review with emphasis on topical non-corticosteroids. PharmacoEconomics 2003; 21(3): 159-179 Indexing Status Subject indexing assigned by NLM MeSH Administration, Topical; Adrenal Cortex Hormones /administration & Adult; Balneology; Child; Dermatitis, Atopic /classification /drug therapy /physiopathology; Economics, Pharmaceutical; Humans; PUVA Therapy; Phototherapy; Quality of Life; Severity of Illness Index; dosage /therapeutic use AccessionNumber 12003008304 Date bibliographic record published 31/01/2006 Date abstract record published 31/01/2006 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. |
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