{"title":"评价Crisaborole治疗儿童轻至中度特应性皮炎的疗效和安全性:一项系统综述和荟萃分析。","authors":"Jianhua You, Huanmei Li, Zhongyun Wang, Yunfei Zhao","doi":"10.12968/hmed.2024.0575","DOIUrl":null,"url":null,"abstract":"<p><p><b>Aims/Background</b> Atopic dermatitis (AD) is a common chronic inflammatory skin disorder globally. Crisaborole, a nonsteroidal topical phosphodiesterase 4 inhibitor (PDE4i), has been utilized in treating AD. Crisaborole regulates the production of inflammatory cytokines, which are usually overactive among AD patients. Therefore, this study aimed to explore the efficacy and safety of crisaborole in treating AD in patients aged ≤18 years. <b>Methods</b> A literature search was performed across PubMed, MEDLINE, Embase, Cochrane, and Google Scholar. The inclusion criteria involved primary studies evaluating the effect of crisaborole in treating dermatitis, articles exploring the use of crisaborole in AD patients below 18 years (>two years), and articles published in English between 2000 and 2022. However, the studies evaluating AD in adult patients, those reporting treatments other than crisaborole, those published before 2000, and articles written in languages other than English were excluded from this analysis. Furthermore, secondary data sources such as case reports, newspaper articles, magazines, and other systematic reviews and meta-analyses were excluded. A meta-analysis was conducted using RevMan 5.4. The risk of bias in the manuscripts was assessed using the Cochrane tool. The I-square test statistic was used to determine heterogeneity, and Egger's test was used to evaluate publication bias. <b>Results</b> Ten studies met the eligibility criteria and were included in the final analysis. Most of the studies exhibited a low risk of bias with no publication bias. Meta-analysis indicated a significant difference in the number of patients attaining Investigator Static Global Assessment (ISGA) success at day 29, with significantly higher patients in the crisaborole group than in the vehicle group (odds ratio (OR) 1.56, 95% CI 1.24 to 1.96; I<sup>2</sup> = 77%; <i>p</i> = 0.0001). Similarly, pruritus improvement was significant between the two cohorts at day 29, indicating significantly higher heterogeneity (OR 1.70, 95% CI 1.10 to 2.63; I<sup>2</sup> = 91%; <i>p</i> = 0.02). Furthermore, the safety profiling of the treatments was insignificant, demonstrating no statistical difference in the treatment-emergent adverse events (TEAEs) between the two groups with high heterogeneity (OR 0.53, 95% CI 0.14 to 1.98; I<sup>2</sup> = 99%; <i>p</i> = 0.35). <b>Conclusion</b> Crisaborole demonstrates substantial efficacy in treating mild to moderate AD compared to vehicle therapies, as it reduces the signs and symptoms of the disease. Furthermore, crisaborole is well tolerated and has an acceptable safety profile in treating mild to moderate AD patients.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-19"},"PeriodicalIF":1.0000,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluating Efficacy and Safety of Crisaborole in Managing Childhood Mild to Moderate Atopic Dermatitis: A Systematic Review and Meta-Analysis.\",\"authors\":\"Jianhua You, Huanmei Li, Zhongyun Wang, Yunfei Zhao\",\"doi\":\"10.12968/hmed.2024.0575\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Aims/Background</b> Atopic dermatitis (AD) is a common chronic inflammatory skin disorder globally. Crisaborole, a nonsteroidal topical phosphodiesterase 4 inhibitor (PDE4i), has been utilized in treating AD. Crisaborole regulates the production of inflammatory cytokines, which are usually overactive among AD patients. Therefore, this study aimed to explore the efficacy and safety of crisaborole in treating AD in patients aged ≤18 years. <b>Methods</b> A literature search was performed across PubMed, MEDLINE, Embase, Cochrane, and Google Scholar. The inclusion criteria involved primary studies evaluating the effect of crisaborole in treating dermatitis, articles exploring the use of crisaborole in AD patients below 18 years (>two years), and articles published in English between 2000 and 2022. However, the studies evaluating AD in adult patients, those reporting treatments other than crisaborole, those published before 2000, and articles written in languages other than English were excluded from this analysis. Furthermore, secondary data sources such as case reports, newspaper articles, magazines, and other systematic reviews and meta-analyses were excluded. A meta-analysis was conducted using RevMan 5.4. The risk of bias in the manuscripts was assessed using the Cochrane tool. The I-square test statistic was used to determine heterogeneity, and Egger's test was used to evaluate publication bias. <b>Results</b> Ten studies met the eligibility criteria and were included in the final analysis. Most of the studies exhibited a low risk of bias with no publication bias. Meta-analysis indicated a significant difference in the number of patients attaining Investigator Static Global Assessment (ISGA) success at day 29, with significantly higher patients in the crisaborole group than in the vehicle group (odds ratio (OR) 1.56, 95% CI 1.24 to 1.96; I<sup>2</sup> = 77%; <i>p</i> = 0.0001). Similarly, pruritus improvement was significant between the two cohorts at day 29, indicating significantly higher heterogeneity (OR 1.70, 95% CI 1.10 to 2.63; I<sup>2</sup> = 91%; <i>p</i> = 0.02). Furthermore, the safety profiling of the treatments was insignificant, demonstrating no statistical difference in the treatment-emergent adverse events (TEAEs) between the two groups with high heterogeneity (OR 0.53, 95% CI 0.14 to 1.98; I<sup>2</sup> = 99%; <i>p</i> = 0.35). <b>Conclusion</b> Crisaborole demonstrates substantial efficacy in treating mild to moderate AD compared to vehicle therapies, as it reduces the signs and symptoms of the disease. Furthermore, crisaborole is well tolerated and has an acceptable safety profile in treating mild to moderate AD patients.</p>\",\"PeriodicalId\":9256,\"journal\":{\"name\":\"British journal of hospital medicine\",\"volume\":\"86 1\",\"pages\":\"1-19\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2025-01-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British journal of hospital medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.12968/hmed.2024.0575\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British journal of hospital medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.12968/hmed.2024.0575","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
目的/背景特应性皮炎(AD)是一种常见的慢性炎症性皮肤病。Crisaborole是一种非甾体外用磷酸二酯酶4抑制剂(PDE4i),已被用于治疗AD。Crisaborole调节炎症细胞因子的产生,炎症细胞因子通常在AD患者中过度活跃。因此,本研究旨在探讨crisaborole治疗≤18岁AD患者的有效性和安全性。方法在PubMed、MEDLINE、Embase、Cochrane、谷歌Scholar等网站进行文献检索。纳入标准包括评价crisaborole治疗皮炎效果的初步研究,探讨crisaborole在18岁以下AD患者中使用的文章,以及2000年至2022年期间发表的英文文章。然而,评估成人AD患者的研究、报告非crisaborole治疗的研究、2000年之前发表的研究以及以非英语语言撰写的文章均被排除在本分析之外。此外,排除了病例报告、报纸文章、杂志和其他系统综述和荟萃分析等二手数据源。采用RevMan 5.4进行meta分析。使用Cochrane工具评估稿件的偏倚风险。采用i方检验统计量判断异质性,采用Egger检验评价发表偏倚。结果10项研究符合入选标准,纳入最终分析。大多数研究表现出低偏倚风险,无发表偏倚。荟萃分析显示,在第29天获得研究者静态全局评估(ISGA)成功的患者数量有显著差异,crisaborole组的患者显著高于载体组(优势比(OR) 1.56, 95% CI 1.24至1.96;I2 = 77%;P = 0.0001)。同样,在第29天,两个队列的瘙痒改善也很显著,这表明异质性明显更高(OR 1.70, 95% CI 1.10至2.63;I2 = 91%;P = 0.02)。此外,治疗的安全性分析不显著,两组之间治疗不良事件(teae)无统计学差异,异质性高(OR 0.53, 95% CI 0.14至1.98;I2 = 99%;P = 0.35)。结论与载体疗法相比,Crisaborole在治疗轻中度AD方面表现出显著的疗效,因为它可以减轻疾病的体征和症状。此外,crisaborole在治疗轻中度AD患者方面具有良好的耐受性和可接受的安全性。
Evaluating Efficacy and Safety of Crisaborole in Managing Childhood Mild to Moderate Atopic Dermatitis: A Systematic Review and Meta-Analysis.
Aims/Background Atopic dermatitis (AD) is a common chronic inflammatory skin disorder globally. Crisaborole, a nonsteroidal topical phosphodiesterase 4 inhibitor (PDE4i), has been utilized in treating AD. Crisaborole regulates the production of inflammatory cytokines, which are usually overactive among AD patients. Therefore, this study aimed to explore the efficacy and safety of crisaborole in treating AD in patients aged ≤18 years. Methods A literature search was performed across PubMed, MEDLINE, Embase, Cochrane, and Google Scholar. The inclusion criteria involved primary studies evaluating the effect of crisaborole in treating dermatitis, articles exploring the use of crisaborole in AD patients below 18 years (>two years), and articles published in English between 2000 and 2022. However, the studies evaluating AD in adult patients, those reporting treatments other than crisaborole, those published before 2000, and articles written in languages other than English were excluded from this analysis. Furthermore, secondary data sources such as case reports, newspaper articles, magazines, and other systematic reviews and meta-analyses were excluded. A meta-analysis was conducted using RevMan 5.4. The risk of bias in the manuscripts was assessed using the Cochrane tool. The I-square test statistic was used to determine heterogeneity, and Egger's test was used to evaluate publication bias. Results Ten studies met the eligibility criteria and were included in the final analysis. Most of the studies exhibited a low risk of bias with no publication bias. Meta-analysis indicated a significant difference in the number of patients attaining Investigator Static Global Assessment (ISGA) success at day 29, with significantly higher patients in the crisaborole group than in the vehicle group (odds ratio (OR) 1.56, 95% CI 1.24 to 1.96; I2 = 77%; p = 0.0001). Similarly, pruritus improvement was significant between the two cohorts at day 29, indicating significantly higher heterogeneity (OR 1.70, 95% CI 1.10 to 2.63; I2 = 91%; p = 0.02). Furthermore, the safety profiling of the treatments was insignificant, demonstrating no statistical difference in the treatment-emergent adverse events (TEAEs) between the two groups with high heterogeneity (OR 0.53, 95% CI 0.14 to 1.98; I2 = 99%; p = 0.35). Conclusion Crisaborole demonstrates substantial efficacy in treating mild to moderate AD compared to vehicle therapies, as it reduces the signs and symptoms of the disease. Furthermore, crisaborole is well tolerated and has an acceptable safety profile in treating mild to moderate AD patients.
期刊介绍:
British Journal of Hospital Medicine was established in 1966, and is still true to its origins: a monthly, peer-reviewed, multidisciplinary review journal for hospital doctors and doctors in training.
The journal publishes an authoritative mix of clinical reviews, education and training updates, quality improvement projects and case reports, and book reviews from recognized leaders in the profession. The Core Training for Doctors section provides clinical information in an easily accessible format for doctors in training.
British Journal of Hospital Medicine is an invaluable resource for hospital doctors at all stages of their career.
The journal is indexed on Medline, CINAHL, the Sociedad Iberoamericana de Información Científica and Scopus.