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Network meta-analysis–based comparison of first-line steroid-sparing adjuvants in the treatment of pemphigus vulgaris and pemphigus foliaceus
- Source :
- Journal of the American Academy of Dermatology. 85:176-186
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background Steroid-sparing adjuvants may enhance oral glucocorticoid benefits in pemphigus treatment. Selecting the optimal therapeutic option among various first-line steroid-sparing adjuvants is often a clinical challenge due to the lack of head-to-head clinical trials. Objective To determine the best first-line steroid-sparing adjuvants for pemphigus treatment. Methods Randomized controlled trials comparing different steroid-sparing adjuvants in patients with pemphigus were identified through a systematic literature search and subjected to a network meta-analysis. The primary outcomes were the proportion of remission and the mean cumulative glucocorticoid dose. Results Ten trials involving 592 patients were analyzed. Among the 7 steroid-sparing adjuvants evaluated, rituximab was the most effective for achieving remission and was more effective than steroid alone (odds ratio, 14.35; 95% confidence interval [CI], 4.71-43.68). Rituximab, azathioprine, and cyclophosphamide pulse therapy enabled the reduction of the cumulative glucocorticoid doses compared to the use of steroid alone: mean differences, −11,830.5 mg (95% CI, −14,089.48 to −9571.52), −3032.48 mg (−4700.74 to −1364.22), and −2469.54 mg (−4128.42 to −810.66), respectively. Limitations The results were driven primarily by a small number of studies, and the effect estimates are imprecise because of indirect comparisons. Conclusion Network meta-analysis showed that rituximab appears to be an efficacious, well tolerated steroid-sparing adjuvant for pemphigus.
- Subjects :
- Oncology
medicine.medical_specialty
medicine.medical_treatment
Network Meta-Analysis
Azathioprine
Dermatology
law.invention
030207 dermatology & venereal diseases
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
Recurrence
law
Internal medicine
medicine
Humans
Immunologic Factors
Cyclophosphamide
Pemphigus foliaceus
Randomized Controlled Trials as Topic
integumentary system
business.industry
Pemphigus vulgaris
Mycophenolic Acid
medicine.disease
Clinical trial
Pemphigus
030220 oncology & carcinogenesis
Cyclosporine
Drug Therapy, Combination
Steroids
Rituximab
business
Adjuvant
medicine.drug
Subjects
Details
- ISSN :
- 01909622
- Volume :
- 85
- Database :
- OpenAIRE
- Journal :
- Journal of the American Academy of Dermatology
- Accession number :
- edsair.doi.dedup.....65641ef41c1cf1d76bb006a83ef79d5b