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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
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 substantial impact on wellbeing. Guidelines suggest first line management with topical treatments but there is little evidence regarding which 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 WHO Trials Registry were searched until June 2020 for randomised 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 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 with CINeMA.

Results: a total of 81 papers were included, reporting 40 trials including 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% v 26%, odds ratio (OR) 1.93, 95% confidence interval (CI) 1.45‐ 2.56; moderate confidence) for improving self‐reported acne. The combinations of BPO with adapalene (54% v 35%, OR 1.88, 1.32‐2.67; low confidence) or with clindamycin (49% v 35%; OR 1.54, 1.14‐2.08; low confidence) were ranked more effective than BPO alone. Participants withdrawing from the trial was reported in 35 trials. Numbers withdrawing due to adverse events were 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+BPO may be the most effective but with a slightly higher incidence of withdrawal than monotherapy. Inconsistent reporting of trial results precluded firmer conclusions.
0007-0963
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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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
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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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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), 512-525. (doi:10.1111/bjd.20080).

Record type: Article

Abstract

Background: acne is very common and can have substantial impact on wellbeing. Guidelines suggest first line management with topical treatments but there is little evidence regarding which 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 WHO Trials Registry were searched until June 2020 for randomised 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 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 with CINeMA.

Results: a total of 81 papers were included, reporting 40 trials including 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% v 26%, odds ratio (OR) 1.93, 95% confidence interval (CI) 1.45‐ 2.56; moderate confidence) for improving self‐reported acne. The combinations of BPO with adapalene (54% v 35%, OR 1.88, 1.32‐2.67; low confidence) or with clindamycin (49% v 35%; OR 1.54, 1.14‐2.08; low confidence) were ranked more effective than BPO alone. Participants withdrawing from the trial was reported in 35 trials. Numbers withdrawing due to adverse events were 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+BPO may be the most effective but with a slightly higher incidence of withdrawal than monotherapy. Inconsistent reporting of trial results precluded firmer conclusions.

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e-pub ahead of print date: 7 April 2021
Additional Information: unding sources: 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.

Identifiers

Local EPrints ID: 448190
URI: http://eprints.soton.ac.uk/id/eprint/448190
ISSN: 0007-0963
PURE UUID: 911edc82-3aa7-4afc-b5e9-ac3e48850d3b
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Emma Maund: ORCID iD orcid.org/0000-0002-3998-6669
ORCID for David Newell: ORCID iD orcid.org/0000-0003-1462-3586
ORCID for Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260

Catalogue record

Date deposited: 14 Apr 2021 16:41
Last modified: 09 Jan 2022 03:59

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Contributors

Author: Beth Stuart ORCID iD
Author: Emma Maund ORCID iD
Author: Christopher Wilcox
Author: Kannan Sridharan
Author: Gowri Sivaramakrishnan
Author: Constantinos Regas
Author: David Newell ORCID iD
Author: Irene Soulsby
Author: Kar Fat Tang
Author: Andrew Y. Finlay
Author: Heiner C. Bucher
Author: Paul Little
Author: Alison M. Layton
Author: Miriam Santer ORCID iD

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