Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Am Acad Dermatol. 2019 May;80(5):1435-1444. doi: 10.1016/j.jaad.2019.01.004. Epub 2019 Jan 14.
Many drugs have been used to treat scabies, but it is unclear which of them is the most efficacious.
To evaluate the comparative efficacy and safety of antiscabietic agents.
A systematic review of randomized controlled trials was conducted. Direct and network meta-analyses were applied to 13 antiscabietic agents on 3 outcomes (cure, persistent itching, and adverse events). Their probability of having highest efficacy and safety was estimated and ranked.
A network meta-analysis of 52 trials including 9917 patients indicated that permethrin (the reference treatment) had a significantly higher cure rate than sulfur, malathion, lindane, crotamiton, and benzyl benzoate. Combination permethrin plus oral ivermectin had a nonsignificantly higher cure rate than permethrin. Combination permethrin plus oral ivermectin was ranked highest in terms of cure, topical ivermectin in terms of persistent itching, and synergized pyrethrins in terms of adverse events. On the basis of clustered ranking, permethrin, oral ivermectin, and synergized pyrethrins seemed to retain balance between cure and adverse events.
There are small numbers of trials and patients in some comparisons and a high risk of bias in some trials.
There is no 1 treatment that ranked highest in all aspects. Physicians should consider the drug's efficacy and safety profiles, along with ease of administration.
有许多药物被用于治疗疥疮，但尚不清楚哪种药物最有效。
评估抗疥疮药物的疗效和安全性。
系统检索了随机对照试验。直接和网络荟萃分析应用于 13 种抗疥疮药物的 3 个结局（治愈、持续瘙痒和不良反应）。评估并对它们的最高疗效和安全性概率进行排名。
纳入 52 项试验共 9917 例患者的网络荟萃分析显示，与硫磺、马拉硫磷、林丹、克罗他米通和苯甲酸苄酯相比，扑灭司林（参照治疗）的治愈率显著更高。与扑灭司林相比，扑灭司林联合口服伊维菌素的治愈率更高，但差异无统计学意义。就治愈率而言，联合使用扑灭司林和口服伊维菌素排名最高，就持续瘙痒而言，局部使用伊维菌素排名最高，而不良反应方面，协同增效除虫菊酯排名最高。基于聚类排名，扑灭司林、口服伊维菌素和协同增效除虫菊酯在疗效和不良反应之间似乎保持平衡。
一些比较的试验和患者数量较少，一些试验存在高偏倚风险。
没有一种治疗方法在所有方面都排名最高。医生应考虑药物的疗效和安全性特征，以及用药的便利性。
