Topical preparations for the treatment of mild to moderate acne vulgaris: systematic review and network meta-analysis
Topical preparations for the treatment of mild to moderate acne vulgaris: systematic review and network meta-analysis
Background: Acne is very common and can have a substantial impact on wellbeing. Guidelines suggest first-line management with topical treatments, but there is little evidence regarding which treatments are most effective. Objectives: To identify the most effective and best tolerated topical treatments for acne using network meta-analysis. Methods: CENTRAL, MEDLINE, Embase and World Health Organization Trials Registry were searched from inception to June 2020 for randomized trials that included participants with mild/moderate acne. Primary outcomes were self-reported improvement in acne, and trial withdrawal. Secondary outcomes included change in lesion counts, Investigator’s Global Assessment, change in quality of life and total number of adverse events. Network meta-analysis was undertaken using a frequentist approach. Risk of bias was assessed using the Cochrane Risk of Bias Tool and confidence in evidence was assessed using CINeMA. Results: A total of 81 papers were included, reporting 40 trials with a total of 18 089 participants. Patient Global Assessment of Improvement was reported in 11 trials. Based on the pooled network estimates, compared with vehicle, benzoyl peroxide (BPO) was effective (35% vs. 26%) for improving self-reported acne. The combinations of BPO with adapalene (54% vs. 35%) or with clindamycin (49% vs. 35%) were ranked more effective than BPO alone. The withdrawal of participants from the trial was reported in 35 trials. The number of patients withdrawing owing to adverse events was low for all treatments. Rates of withdrawal were slightly higher for BPO with adapalene (2·5%) or clindamycin (2·7%) than BPO (1·6%) or adapalene alone (1·0%). Overall confidence in the evidence was low. Conclusions: Adapalene in combination with BPO may be the most effective treatment for acne but with a slightly higher incidence of withdrawal than monotherapy. Inconsistent reporting of trial results precluded firmer conclusions.
512-525
Stuart, Beth
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Maund, Emma
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Wilcox, Christopher
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Sridharan, Kannan
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Sivaramakrishnan, Gowri
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Regas, Constantinos
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Newell, David
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Soulsby, Irene
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Tang, Kar Fat
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Finlay, Andrew Y.
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Bucher, Heiner C.
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Little, Paul
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Layton, Alison M.
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Santer, Miriam
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7 April 2021
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
Wilcox, Christopher
dd406779-15d1-494e-b3f3-38db0e453be7
Sridharan, Kannan
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Sivaramakrishnan, Gowri
46d8e154-7c70-4129-9afc-0bdec74187cb
Regas, Constantinos
eef3cec5-ec27-44f2-91d5-19bdc30285dd
Newell, David
f1a21938-9604-4f10-aac2-bb19337a638e
Soulsby, Irene
96080278-1724-45a0-9066-5e2dfdde90af
Tang, Kar Fat
a8700685-3766-43d0-b459-e151cc27de3a
Finlay, Andrew Y.
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Bucher, Heiner C.
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Layton, Alison M.
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Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Stuart, Beth, Maund, Emma, Wilcox, Christopher, Sridharan, Kannan, Sivaramakrishnan, Gowri, Regas, Constantinos, Newell, David, Soulsby, Irene, Tang, Kar Fat, Finlay, Andrew Y., Bucher, Heiner C., Little, Paul, Layton, Alison M. and Santer, Miriam
(2021)
Topical preparations for the treatment of mild to moderate acne vulgaris: systematic review and network meta-analysis.
British Journal of Dermatology, 185 (3), .
(doi:10.1111/bjd.20080).
Abstract
Background: Acne is very common and can have a substantial impact on wellbeing. Guidelines suggest first-line management with topical treatments, but there is little evidence regarding which treatments are most effective. Objectives: To identify the most effective and best tolerated topical treatments for acne using network meta-analysis. Methods: CENTRAL, MEDLINE, Embase and World Health Organization Trials Registry were searched from inception to June 2020 for randomized trials that included participants with mild/moderate acne. Primary outcomes were self-reported improvement in acne, and trial withdrawal. Secondary outcomes included change in lesion counts, Investigator’s Global Assessment, change in quality of life and total number of adverse events. Network meta-analysis was undertaken using a frequentist approach. Risk of bias was assessed using the Cochrane Risk of Bias Tool and confidence in evidence was assessed using CINeMA. Results: A total of 81 papers were included, reporting 40 trials with a total of 18 089 participants. Patient Global Assessment of Improvement was reported in 11 trials. Based on the pooled network estimates, compared with vehicle, benzoyl peroxide (BPO) was effective (35% vs. 26%) for improving self-reported acne. The combinations of BPO with adapalene (54% vs. 35%) or with clindamycin (49% vs. 35%) were ranked more effective than BPO alone. The withdrawal of participants from the trial was reported in 35 trials. The number of patients withdrawing owing to adverse events was low for all treatments. Rates of withdrawal were slightly higher for BPO with adapalene (2·5%) or clindamycin (2·7%) than BPO (1·6%) or adapalene alone (1·0%). Overall confidence in the evidence was low. Conclusions: Adapalene in combination with BPO may be the most effective treatment for acne but with a slightly higher incidence of withdrawal than monotherapy. Inconsistent reporting of trial results precluded firmer conclusions.
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topical
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e-pub ahead of print date: 7 April 2021
Published date: 7 April 2021
Additional Information:
Funding Information:
This study is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (NIHR SPCR grant number 442). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder played no role in the design of the study, collection, analysis and interpretation of data, or writing of the manuscript. Funding sources
Publisher Copyright:
© 2021 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists
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Local EPrints ID: 448190
URI: http://eprints.soton.ac.uk/id/eprint/448190
ISSN: 0007-0963
PURE UUID: 911edc82-3aa7-4afc-b5e9-ac3e48850d3b
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Date deposited: 14 Apr 2021 16:41
Last modified: 12 Jul 2024 01:59
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Contributors
Author:
Christopher Wilcox
Author:
Kannan Sridharan
Author:
Gowri Sivaramakrishnan
Author:
Constantinos Regas
Author:
Irene Soulsby
Author:
Kar Fat Tang
Author:
Andrew Y. Finlay
Author:
Heiner C. Bucher
Author:
Alison M. Layton
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