Ghazal Stephanie, Ridha Zainab, D'Aguanno Kathleen, Nassim David, Quaiattini Andrea, Netchiporouk Elena, Poulin Yves, Kalia Sunil, Marcoux Danielle, Piguet Vincent, Jack Carolyn
Faculty of Medicine, McGill University, Montreal, QC, Canada.
Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
Front Med (Lausanne). 2022 Mar 9;9:821871. doi: 10.3389/fmed.2022.821871. eCollection 2022.
Since its approval for adults with moderate-to-severe atopic dermatitis (AD) in 2017, dupilumab has been incorporated into clinical practice guidelines (CPGs). However, recommendations differ internationally, and the quality assessment of their development is unclear.
We aimed to systematically review and appraise the quality of CPGs for adult AD reported since 2017 and map the recommendations for dupilumab initiation relative to conventional systemic therapy (CST).
A literature search was conducted in June 2020 in MEDLINE, EMBASE, SCOPUS, and CINAHL. Twelve CPGs were retrieved. Methodological quality was assessed using the validated Appraisal of Guidelines for Research & Evaluation II tool (AGREE-II). Recommendations were extracted and compared.
AGREE-II median scores per domain of the CPGs were (%, r = range): scope/purpose, 78% (50-96); stakeholder involvement, 54% (28-85); rigor of development, 39% (21-63); clarity of presentation, 85% (69-100); applicability, 27% (6-51); and editorial independence, 76% (42-100). Neither met the threshold of 70% quality criteria for rigor of development nor the applicability domains. Three CPGs met the criteria for recommendation without modification. CPGs' approach to dupilumab initiation was as follows: second line, preferred over CST and nbUVB ( = 1/12 CPG); second line, equivalent to CST or nbUVB ( = 3/12 CPGs); third line, after nbUVB or CST ( = 5/12 CPGs); and fourth line after nbUVB and CST ( = 2/12). No consensus was reached for = 1/12 CPG.
Dupilumab is now incorporated into CPGs for adult AD. These CPGs exhibited good quality in scope/purpose, clarity, and editorial independence domains. However, none met AGREE-II criteria for methodological rigor/applicability. Gaps were found in mechanisms for updates, facilitators/barriers, resource implications, and stakeholder involvement. Only = 3/12 CPGs met quality criteria for recommendation without modifications. Of these, two favored a conservative sequential approach for the initiation of dupilumab relative to CST, while one did not reach consensus. Our findings highlight divergent recommendations AD treatment, underlining a need to incorporate quality criteria into future guideline development.
自2017年被批准用于治疗中度至重度特应性皮炎（AD）成人患者以来，度普利尤单抗已被纳入临床实践指南（CPG）。然而，国际上的推荐意见存在差异，且其制定过程的质量评估尚不清楚。
我们旨在系统回顾和评估2017年以来报道的成人AD的CPG质量，并梳理相对于传统全身治疗（CST）开始使用度普利尤单抗的推荐意见。
2020年6月在MEDLINE、EMBASE、SCOPUS和CINAHL中进行文献检索。共检索到12篇CPG。使用经过验证的《研究与评价指南评估II》工具（AGREE-II）评估方法学质量。提取并比较推荐意见。
CPG各领域的AGREE-II中位数得分（%，r = 范围）为：范围/目的，78%（50 - 96）；利益相关者参与，54%（28 - 85）；制定的严谨性，39%（21 - 63）；表述清晰度，85%（69 - 100）；适用性，27%（6 - 51）；编辑独立性，76%（42 - 100）。在制定严谨性和适用性领域，均未达到70%质量标准的阈值。3篇CPG符合无需修改的推荐标准。CPG关于开始使用度普利尤单抗的方法如下：二线，优先于CST和窄谱中波紫外线（nbUVB）（n = 1/12篇CPG）；二线，等同于CST或nbUVB（n = 3/12篇CPG）；三线，在nbUVB或CST之后（n = 5/12篇CPG）；四线，在nbUVB和CST之后（n = 2/12）。1/12篇CPG未达成共识。
度普利尤单抗现已被纳入成人AD的CPG。这些CPG在范围/目的、清晰度和编辑独立性领域表现出良好质量。然而，没有一篇符合AGREE-II关于方法学严谨性/适用性的标准。在更新机制以及促进因素/障碍、资源影响和利益相关者参与方面存在差距。只有3/12篇CPG符合无需修改的推荐质量标准。其中，两篇相对于CST更倾向于采用保守的序贯方法开始使用度普利尤单抗，而另一篇未达成共识。我们的研究结果凸显了AD治疗推荐意见的差异，强调在未来指南制定中纳入质量标准的必要性。
