Safety of topical corticosteroids in atopic eczema: an umbrella review

被引:47
作者
Axon, Emma [1 ]
Chalmers, Joanne R. [1 ]
Santer, Miriam [2 ]
Ridd, Matthew J. [3 ]
Lawton, Sandra [4 ]
Langan, Sinead M. [5 ]
Grindlay, Douglas J. C. [1 ]
Muller, Ingrid [2 ]
Roberts, Amanda [1 ]
Ahmed, Amina [1 ]
Williams, Hywel C. [1 ]
Thomas, Kim S. [1 ]
机构
[1] Univ Nottingham, Ctr Evidence Based Dermatol, Nottingham, England
[2] Univ Southampton, Primary Care & Populat Sci, Southampton, Hants, England
[3] Univ Bristol, Fac Hlth Sci, Populat Hlth Sci, Bristol, Avon, England
[4] Rotherham NHS Fdn Trust, Dermatol Dept, Rotherham, S Yorkshire, England
[5] London Sch Hyg & Trop Med, Fac Epidemiol & Populat Hlth, London, England
基金
英国惠康基金;
关键词
eczema; paediatric dermatology; adult dermatology; WET-WRAP DRESSINGS; FLUTICASONE PROPIONATE CREAM; FLUOCINOLONE ACETONIDE 0.01-PERCENT; 0.1-PERCENT TACROLIMUS OINTMENT; PITUITARY-ADRENAL AXIS; DOUBLE-BLIND; CALCINEURIN INHIBITORS; MAINTENANCE TREATMENT; PEDIATRIC-PATIENTS; DILUTED CORTICOSTEROIDS;
D O I
10.1136/bmjopen-2020-046476
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective An umbrella review summarising all safety data from systematic reviews of topical corticosteroids (TCS) in adults and children with atopic eczema. Methods Embase, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and the Centre of Evidence Based Dermatology map of eczema systematic reviews were searched until 7 November 2018 and Epistemonikos until 2 March 2021. Reviews were included if they assessed the safety of TCS in atopic eczema and searched >1 database using a reproducible search strategy. Review quality was assessed using version 2 of 'A MeaSurement Tool to Assess systematic Reviews' (AMSTAR 2 tool). Results 38 systematic reviews included, 34 low/critically low quality. Treatment and follow-up were usually short (2-4 weeks). Key findings TCS versus emollient/vehicle: No meta-analyses identified for skin-thinning. Two 2-week randomised controlled trials (RCTs) found no significant increased risk with very potent TCS (0/196 TCS vs 0/33 vehicle in children and 6/109 TCS vs 2/50 vehicle, age unknown). Biochemical adrenal suppression (cortisol) was 3.8% (95% CI 2.4% to 5.8%) in a meta-analysis of 11 uncontrolled observational studies (any potency TCS, 522 children). Effects reversed when treatment ceased. TCS versus topical calcineurin inhibitors: Meta-analysis showed higher relative risk of skin thinning with TCS (4.86, 95% CI 1.06 to 22.28, n=4128, four RCTs, including one 5-year RCT). Eight cases in 2068 participants, 7 using potent TCS. No evidence of growth suppression. Once daily versus more frequent TCS: No meta-analyses identified. No skin-thinning in one RCT (3 weeks potent TCS, n=94) or biochemical adrenal suppression in two RCTs (up to 2 weeks very potent/moderate TCS, n=129). TCS twice/week to prevent flares ('weekend therapy') versus vehicle: No meta-analyses identified. No evidence of skin thinning in five RCTs. One RCT found biochemical adrenal suppression (2/44 children, potent TCS). Conclusions We found no evidence of harm when TCS were used intermittently 'as required' to treat flares or 'weekend therapy' to prevent flares. However, long-term safety data were limited. PROSPERO registration number CRD42018079409.
引用
收藏
页数:12
相关论文
共 120 条
[1]  
Abramovits William, 2010, Skinmed, V8, P150
[2]   The prevalence of atopic dermatitis beyond childhood: A systematic review and meta-analysis of longitudinal studies [J].
Abuabara, K. ;
Yu, A. M. ;
Okhovat, J. -P. ;
Allen, I. E. ;
Langan, S. M. .
ALLERGY, 2018, 73 (03) :696-704
[3]  
[Anonymous], 2017, COV SYST REV SOFTW
[4]  
[Anonymous], 2013, GRADE handbook for grading quality of evidence and strength of recommendations
[5]   Risk of lymphoma following exposure to calcineurin inhibitors and topical steroids in patients with atopic dermatitis [J].
Arellano, Felix M. ;
Wentworth, Charles E. ;
Arana, Alejandro ;
Fernandez, Carlos ;
Paul, Carle F. .
JOURNAL OF INVESTIGATIVE DERMATOLOGY, 2007, 127 (04) :808-816
[6]   Topical pimecrolimus for eczema [J].
Ashcroft, D. M. ;
L-C, Chen ;
Garside, R. ;
Stein, K. ;
Williams, H. C. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2007, (04)
[7]   Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: meta-analysis of randomised controlled trials [J].
Ashcroft, DM ;
Dimmock, P ;
Garside, R ;
Stein, K ;
Williams, HC .
BMJ-BRITISH MEDICAL JOURNAL, 2005, 330 (7490) :516-522
[8]   Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency [J].
Aubert-Wastiaux, H. ;
Moret, L. ;
Le Rhun, A. ;
Fontenoy, A. M. ;
Nguyen, J. M. ;
Leux, C. ;
Misery, L. ;
Young, P. ;
Chastaing, M. ;
Danou, N. ;
Lombrail, P. ;
Boralevi, F. ;
Lacour, J. P. ;
Mazereeuw-Hautier, J. ;
Stalder, J. -F. ;
Barbarot, S. .
BRITISH JOURNAL OF DERMATOLOGY, 2011, 165 (04) :808-814
[9]   Topical Corticosteroid-Induced Skin Atrophy: A Comprehensive Review [J].
Barnes, Laurent ;
Kaya, Gurkan ;
Rollason, Victoria .
DRUG SAFETY, 2015, 38 (05) :493-509
[10]   The Eczema Priority Setting Partnership: a collaboration between patients, carers, clinicians and researchers to identify and prioritize important research questions for the treatment of eczema [J].
Batchelor, J. M. ;
Ridd, M. J. ;
Clarke, T. ;
Ahmed, A. ;
Cox, M. ;
Crowe, S. ;
Howard, M. ;
Lawton, S. ;
McPhee, M. ;
Rani, A. ;
Ravenscroft, J. C. ;
Roberts, A. ;
Thomas, K. S. .
BRITISH JOURNAL OF DERMATOLOGY, 2013, 168 (03) :577-582