Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
Department of Dental Training, Ministry of Health, Manama, Kingdom of Bahrain.
Pediatr Surg Int. 2021 Aug;37(8):1117-1125. doi: 10.1007/s00383-021-04906-1. Epub 2021 May 15.
Corticosteroids and hyaluronidase are trialed for treating phimosis in children. We carried out the present network meta-analysis to compare the therapeutic effect of these drugs.
Electronic databases were searched for appropriate randomized clinical trials. Odds ratio (OR) with 95% confidence intervals (95% CI) was used as the effect estimate. A random-effects model was used for generating the pooled estimates. Rankogram plot was used for ranking the drugs.
Proportions of patients with remission (partial/complete) and with complete remission.
Mometasone (OR 6.53, 95% CI 2.85, 14.96), betamethasone/hyaluronidase (OR 12.1, 95% CI 4.27, 34.49), triamcinolone (OR 19.15, 95% CI 4.47, 81.96), dexamethasone (OR 21.38, 95% CI 5.71, 79.98), betamethasone (OR 23.02, 95% CI 6.92, 79.54), hydrocortisone (OR 23.2, 95% CI 5.91, 91.02) and methylprednisolone (OR 50.47, 95% CI 4.45, 572.72) were observed with significantly higher proportions of patients with remission (partial/complete) compared to placebo. Dexamethasone, triamcinolone, betamethasone, betamethasone/hyaluronidase, clobetasol, mometasone, and hydrocortisone were observed with significantly higher proportions of patients with complete remission compared to placebo. Beclomethasone was not observed to be superior to either placebo or other drugs. Rankogram plot revealed methylprednisolone followed by hydrocortisone had the maximum statistical probability of being 'the best' in the pool for remission and betamethasone followed by hydrocortisone for complete remission.
Topical methylprednisolone, hydrocortisone, and betamethasone were observed with better clinical resolution of phimosis compared to other corticosteroids. Very high potent corticosteroids like beclomethasone and clobetasol were not observed with superior benefits compared to other corticosteroids. Considering low-potency, hydrocortisone shall be preferred until further evidence emerges.
皮质类固醇和透明质酸酶已被尝试用于治疗儿童包茎。本研究进行了网络荟萃分析，以比较这些药物的治疗效果。
检索电子数据库以寻找合适的随机临床试验。比值比（OR）及其 95%置信区间（95%CI）用于评估效应。使用随机效应模型生成汇总估计值。秩图用于对药物进行排序。
患者缓解（部分/完全）和完全缓解的比例。
莫米松（OR 6.53，95%CI 2.85，14.96）、倍他米松/透明质酸酶（OR 12.1，95%CI 4.27，34.49）、曲安奈德（OR 19.15，95%CI 4.47，81.96）、地塞米松（OR 21.38，95%CI 5.71，79.98）、倍他米松（OR 23.02，95%CI 6.92，79.54）、氢化可的松（OR 23.2，95%CI 5.91，91.02）和甲泼尼龙（OR 50.47，95%CI 4.45，572.72）的患者缓解（部分/完全）比例显著高于安慰剂。地塞米松、曲安奈德、倍他米松、倍他米松/透明质酸酶、氯倍他索、莫米松和氢化可的松的患者完全缓解比例显著高于安慰剂。倍氯米松与安慰剂或其他药物相比，并未显示出优势。秩图显示，甲泼尼龙紧随其后的是氢化可的松，在缓解方面，它们在池中有最大的统计学概率成为“最佳”，而在完全缓解方面，紧随其后的是倍他米松和氢化可的松。
与其他皮质类固醇相比，局部应用甲泼尼龙、氢化可的松和倍他米松可更好地治疗包茎。与其他皮质类固醇相比，强效皮质类固醇如倍氯米松和氯倍他索并未显示出更好的获益。鉴于低效能，在出现进一步证据之前，应首选氢化可的松。
