| Title: |
A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris |
| Authors: |
Mavranezouli, Ifigeneia; Daly, Caitlin H; Welton, Nicky J; Deshpande, Shalmali; Berg, Laura; Bromham, Nathan; Arnold, Stephanie; Phillippo, David M; Wilcock, Jane; Xu, Jingyuan; Ravenscroft, Jane C; Wood, Damian; Rafiq, Mohammed; Fou, Linyun; Dworzynski, Katharina; Healy, Eugene |
| Source: |
Mavranezouli, I, Daly, C H, Welton, N J, Deshpande, S, Berg, L, Bromham, N, Arnold, S, Phillippo, D M, Wilcock, J, Xu, J, Ravenscroft, J C, Wood, D, Rafiq, M, Fou, L, Dworzynski, K & Healy, E 2022, 'A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris', British Journal of Dermatology, vol. 187, no. 5, pp. 639-649. https://doi.org/10.1111/bjd.21739 |
| Publication Year: |
2022 |
| Collection: |
University of Bristol: Bristol Reserach |
| Subject Terms: |
Humans; Isotretinoin/therapeutic use; Network Meta-Analysis; Acne Vulgaris/drug therapy; Anti-Bacterial Agents/therapeutic use; Tetracycline |
| Description: |
BACKGROUND: Various treatments for acne vulgaris exist, but little is known about their comparative effectiveness in relation to acne severity. OBJECTIVES: To identify best treatments for mild-to-moderate and moderate-to-severe acne, as determined by clinician-assessed morphological features. METHODS: We undertook a systematic review and network meta-analysis of randomized controlled trials (RCTs) assessing topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, published up to May 2020. Outcomes included percentage change in total lesion count from baseline, treatment discontinuation for any reason, and discontinuation owing to side-effects. Risk of bias was assessed using the Cochrane risk-of-bias tool and bias adjustment models. Effects for treatments with ≥ 50 observations each compared with placebo are reported below. RESULTS: We included 179 RCTs with approximately 35 000 observations across 49 treatment classes. For mild-to-moderate acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with benzoyl peroxide (BPO) [mean difference 26·16%, 95% credible interval (CrI) 16·75-35·36%]; physical - chemical peels, e.g. salicylic or mandelic acid (39·70%, 95% CrI 12·54-66·78%) and photochemical therapy (combined blue/red light) (35·36%, 95% CrI 17·75-53·08%). Oral pharmacological treatments (e.g. antibiotics, hormonal contraceptives) did not appear to be effective after bias adjustment. BPO and topical retinoids were less well tolerated than placebo. For moderate-to-severe acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with lincosamide (clindamycin) (44·43%, 95% CrI 29·20-60·02%); oral pharmacological - isotretinoin of total cumulative dose ≥ 120 mg kg -1 per single course (58·09%, 95% CrI 36·99-79·29%); physical - photodynamic therapy (light therapy enhanced by a photosensitizing chemical) (40·45%, 95% CrI ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/35789996; info:eu-repo/semantics/altIdentifier/hdl/https://hdl.handle.net/1983/2a53d808-863c-4c10-ac17-922d29a276ff |
| DOI: |
10.1111/bjd.21739 |
| Availability: |
https://hdl.handle.net/1983/2a53d808-863c-4c10-ac17-922d29a276ff; https://research-information.bris.ac.uk/en/publications/2a53d808-863c-4c10-ac17-922d29a276ff; https://doi.org/10.1111/bjd.21739; https://research-information.bris.ac.uk/ws/files/358336078/bjd0639.pdf |
| Rights: |
info:eu-repo/semantics/openAccess ; http://creativecommons.org/licenses/by-nc/4.0/ |
| Accession Number: |
edsbas.EE3D612D |
| Database: |
BASE |