Treatment Guidelines for Atopic Dermatitis Since the Approval of Dupilumab: A Systematic Review and Quality Appraisal Using AGREE-II

Frontiers in Medicine

article

Stephanie Ghazal¹  Zainab Ridha²  Kathleen D'Aguanno¹  David Nassim¹  Andrea Quaiattini³  Elena Netchiporouk⁴  Yves Poulin⁶  Sunil Kalia⁷  Danielle Marcoux⁸  Vincent Piguet⁹  Carolyn Jack¹ 

[1] Faculty of Medicine, McGill University;Faculty of Medicine, Université Laval;Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University;Division of Dermatology, McGill University Health Center;Infectious Diseases and Immunity in Global Health, The Research Institute of the McGill University Health Center;Centre de Recherche Dermatologique du Québec Métropolitain;Department of Dermatology and Skin Science, Vancouver Coastal Health Research Institute;Department of Pediatrics, Division of Dermatology, Sainte-Justine University Hospital Center, University of Montreal;Division of Dermatology, Department of Medicine, University of Toronto;Division of Dermatology, Women's College Hospital;Divisions of Dermatology, St. Mary's Hospital, Montreal West Island Integrated University Health and Social Services Centre;Jewish General Hospital, Montreal West-Central Integrated University Health and Social Services Centre

关键词: dupilumab;    treatment guideline;    atopic dermatitis;    systematic review;    quality appraisal;    AGREE-II;   

DOI  :  10.3389/fmed.2022.821871

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Introduction 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. Objective 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). Materials and Methods 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. Results 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 ( n = 1/12 CPG); second line, equivalent to CST or nbUVB ( n = 3/12 CPGs); third line, after nbUVB or CST ( n = 5/12 CPGs); and fourth line after nbUVB and CST ( n = 2/12). No consensus was reached for n = 1/12 CPG. Conclusion and Relevance 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 n = 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.

【 授权许可】

CC BY