Al-Dhubaibi Mohammed Saleh, Settin Ahmad Abdulsalam
Department of Dermatology, College of Medicine, Qassim University, Saudi Arabia.
Department of Pediatrics, College of Medicine, Qassim University, Saudi Arabia.
Int J Health Sci (Qassim). 2018 Mar-Apr;12(2):70-79.
Alitretinoin is a new oral retinoid authorized for use in grownups that have severe chronic hand eczema (CHE). A comprehensive search to solicit all studies of alitretinoin for the treatment of CHE. A comprehensive search to solicit all studies of alitretinoin for the treatment of CHE including randomized controlled trials (RCTs) or uncontrolled trials, re-treatment studies, open-label studies, or observational studies, along with case series of 10 or more participants. Physician global assessment (PGA), patient global assessment (PaGA) and modified total lesion symptom score (mTLSS) are the methods and outcomes criteria. Generated effect size and 95% confidence intervals were calculated for the outcomes. Heterogeneity and publication bias were also tested for all selected trials. When a noteworthy Q statistic ( < 0.1) demonstrates the heterogeneity crosswise over studies, an arbitrary impact model is used. On the other hand, a settled effect model is when heterogeneity is not shown. The initial search yielded 408 records of which 15 articles were selected. The 15 clinical trials included 3734 patients with CHE. Among alitretinoin-treated patients, the PGA effect size was directly proportional to the drug dosage, ranging from 40% to 69%, while the PaGA score ranged from 28.8% to 62.4%, and mTLSS ranged from 60.4% to 76.9%, much higher than placebo. A higher drug dose was about twice as effective as lower dose. The odds ratio for a better outcome with drug treatment taking duration into account was about 3-4 times that versus placebo. In conclusions, alitretinoin cleared lesions in about 50% of cases, particularly using a higher dose for a longer duration.
阿利维A酸是一种新的口服类维生素A药物，被批准用于治疗患有严重慢性手部湿疹（CHE）的成年人。进行全面检索以收集所有关于阿利维A酸治疗CHE的研究。全面检索以收集所有关于阿利维A酸治疗CHE的研究，包括随机对照试验（RCT）或非对照试验、再治疗研究、开放标签研究或观察性研究，以及10名或更多参与者的病例系列。医生整体评估（PGA）、患者整体评估（PaGA）和改良总皮损症状评分（mTLSS）是方法和结果标准。计算结果的效应大小和95%置信区间。还对所有选定试验进行异质性和发表偏倚测试。当显著的Q统计量（<0.1）表明研究间存在异质性时，使用随机效应模型。另一方面，当未显示异质性时使用固定效应模型。初步检索产生了408条记录，其中15篇文章被选中。这15项临床试验包括3734例CHE患者。在接受阿利维A酸治疗的患者中，PGA效应大小与药物剂量成正比，范围为40%至69%，而PaGA评分范围为28.8%至62.4%，mTLSS范围为60.4%至76.9%，远高于安慰剂。较高药物剂量的疗效约为较低剂量的两倍。考虑治疗持续时间时，药物治疗取得更好结果的优势比约为安慰剂的3至4倍。总之，阿利维A酸在约50%的病例中清除了皮损，尤其是使用较高剂量并持续较长时间时。
