How clinically relevant are treatment comparisons of topical calcineurin inhibitor trials for atopic eczema?

Wilkes, Sally R., Nankervis, Helen, Tavernier, Elsa, Maruani, Annabel and Williams, Hywel C. (2016) How clinically relevant are treatment comparisons of topical calcineurin inhibitor trials for atopic eczema? Journal of Investigative Dermatology, 136 (10). pp. 1944-1949. ISSN 1523-1747

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We sought to explore the architecture of trials of calcineurin inhibitors for atopic eczema to document the extent to which comparisons with active treatments such as topical corticosteroids (TCS) might have been included or avoided. We identified all eligible randomized controlled trials (RCTs) using the Global Resource for EczemA Trials database. Network plots were produced where the nodes represented a treatment type and the lines between the nodes represented the number of trials or participants that were involved in the various treatment comparisons. A total of 174 RCTs for atopic eczema treatments were identified where pimecrolimus, tacrolimus or topical corticosteroids were compared with another intervention or a vehicle/emollient. Of 39 trials involving pimecrolimus and of 41 trials involving tacrolimus, 8 (20.5%) and 13 (31.7%) respectively made comparisons with topical corticosteroids, and 25 (64.1%) and 15 (36.6%) respectively were vehicle-controlled studies. The high rate of comparisons with vehicle controls in RCTs assessing the efficacy of pimecrolimus or tacrolimus long after efficacy had been established is a matter of concern. Active comparators (mild TCS for pimecrolimus and moderate to potent TCS for tacrolimus) are best placed to inform how topical calcineurin inhibitors compare to established clinical practice.

Item Type: Article
Keywords: Atopic eczema; Topical corticosteroids; Calcineurin inhibitors; Randomised clinical trial; Network geometry
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Rheumatology, Orthopaedics and Dermatology
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Depositing User: Eprints, Support
Date Deposited: 10 Jul 2016 17:08
Last Modified: 04 May 2020 18:00

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