Quality of systematic reviews on the treatment of vesiculobullous skin diseases. A meta-epidemiological study<sup/>

Sá, Kamilla Mayr Martins; Rodrigues, Juliana Cavaleiro; Silva, Lígia Borges da; Santos, Giovanna Marcılio; Colovati, Mileny Esbravatti Stephano; Martimbianco, Ana Luiza Cabrera

doi:10.1016/j.abd.2023.06.003

Kamilla Mayr Martins Sá ^** Corresponding author. E-mail: kamillamm@hotmail.com.br (K.M. Sá).

Conception and design of the study

data collection

article writing

acquisition

analysis

and interpretation of data

critical review of the literature

and final approval of the final version of the manuscript.

Department of Medicine, Universidade Metropolitana de Santos, Santos, SP, Brazil

http://orcid.org/0000-0001-9018-5587

Juliana Cavaleiro Rodrigues

Acquisition

analysis

and interpretation of data

critical review of the literature

final approval of the final version of the manuscript.

Department of Medicine, Universidade Metropolitana de Santos, Santos, SP, Brazil

http://orcid.org/0000-0002-3503-605X

Lígia Borges da Silva

Acquisition

analysis

and interpretation of data

critical review of the literature

final approval of the final version of the manuscript.

Department of Medicine, Universidade Metropolitana de Santos, Santos, SP, Brazil

http://orcid.org/0000-0001-7918-2270

Giovanna Marcılio Santos

A critical review of the literature

critical review of important intellectual content

and final approval of the final version of the manuscript.

Department of Medicine, Universidade Metropolitana de Santos, Santos, SP, Brazil

http://orcid.org/0000-0002-7195-339X

Mileny Esbravatti Stephano Colovati

A critical review of the literature

critical review of important intellectual content

final approval of the final version of the manuscript.

Postgraduate Program in Health and Environment, Department of Medicine, Universidade Metropolitana de Santos, Santos, SP, Brazil

http://orcid.org/0000-0001-9531-6144

Ana Luiza Cabrera Martimbianco

Conception and design of the study

effective participation in the orientation of the research

article writing and critical review of important intellectual content

acquisition

analysis

and interpretation of data

critical review of the literature

final approval of the final version of the manuscript.

Postgraduate Program in Health and Environment, Department of Medicine, Universidade Metropolitana de Santos, Santos, SP, Brazil

Health Technology Assessment Center, Hospital Sírio-Libanês, São Paulo, SP, Brazil

http://orcid.org/0000-0002-4361-4526

⋆
Study conducted at the Universidade Metropolitana de Santos, Santos, SP, Brazil.

* Corresponding author. E-mail: kamillamm@hotmail.com.br (K.M. Sá).

Conflicts of interest

None declared.

Search strategy

(“Skin Diseases, Vesiculobullous” [Mesh] OR (Skin Disease, Vesiculobullous) AND (Vesiculobullous Skin Disease) OR (Vesiculobullous Skin Diseases) OR (Vesiculobullous Dermatoses) OR (Dermatoses, Vesiculobullous) OR (Skin Diseases, Bullous) OR (Bullous Skin Disease) OR (Skin Disease, Bullous) OR (Bullous Skin Diseases) OR (Bullous Dermatoses) OR (Dermatoses, Bullous) OR (Vesicular Skin Diseases) OR (Skin Disease, Vesicular) OR (Vesicular Skin Disease) OR (Skin Diseases, Vesicular) OR (Pustular Dermatosis, Subcorneal) OR (Dermatoses, Subcorneal Pustular) OR (Dermatosis, Subcorneal Pustular) OR (Pustular Dermatoses, Subcorneal) OR (Subcorneal Pustular Dermatoses) OR (Sneddon-Wilkinson Disease) OR (Sneddon Wilkinson Disease) OR (Subcorneal Pustular Dermatosis)) AND (systematic [sb])

Systematic reviews	Included RCT (n)	Population	Interventions and comparators	Outcome assessed by the systematic reviews	Financial sources
Asilian 2021²²22 Asilian A, Safaei H, Iraji F, Fatemi Naeini F, Faghihi G, Mokhtari F. Interventions for bullous pemphigoid: An updated systematic review of randomized clinical trials. Med J Islam Repub Iran. 2021;35:111.	3	Bullous pemphigoid	Methylprednisolone	Mortality	No funding sources reported.
			Azathioprine	Disease control
			Dapsone	Adverse Events
			Doxycycline	Time to complete response
			Prednisolone
			Intravenous immunoglobulin
Atzmony 2014²³23 Atzmony L, Hodak E, Gdalevich M, Rosenbaum O, Mimouni D. Treatment of pemphigus vulgaris and pemphigus foliaceus: a systematic review and meta-analysis. Am J Clin Dermatol. 2014;15:503-15.	20	Pemphigus vulgaris, pemphigus foliaceus	Azathioprine	Complete response	No funding sources reported.
			Mycophenolate mofetil	Mean total cumulative glucocorticoid dose
			Cyclophosphamide	Mean total cumulative glucocorticoid dose
			Intravenous immunoglobulin	Mortality
				Disease control
				Remission
				Relapse
				Withdrawal due to adverse events
Atzmony 2015²⁴24 Atzmony L, Hodak E, Leshem YA, Rosenbaum O, Gdalevich M, Anhalt GJ, et al. The role of adjuvant therapy in pemphigus: A systematic review and meta-analysis. J Am Acad Dermatol. 2015;73:264-71.	10	Pemphigus vulgaris, pemphigus foliaceus	Glucocorticoid	Remission	No funding sources reported.
			Azathioprine	Disease control
			Mycophenolate mofetil	Relapse
			Cyclophosphamide	Cumulative glucocorticoid dose
			Cyclosporine	Withdrawal due to adverse events
			Intravenous immunoglobulin plasma exchange	Mortality
			Infliximab	Mortality
Kirtschig 2010²⁵25 Kirtschig G, Middleton P, Bennett C, Murrell DF, Wojnarowska F, Khumalo NP. Interventions for bullous pemphigoid. Cochrane Database Syst Rev. 2010;CD002292.	10	Bullous pemphigoid	Prednisolone	Disease control	No funding sources reported.
			Azathioprine	Mortality
			Plasma exchange	Overall improvement
			Mycophenolate mofetil, tetracycline	Several adverse events
			Nicotinamide	Quality of life
			Chinese traditional medicine	Remission
				Systemic infection
				Organ failure
				Allergic reactions
Garcia-Doval 2013²⁶26 Garcia-Doval I, Davila-Seijo P, Langan SM. Updated systematic review of randomized controlled trials of treatments for inherited forms of epidermolysis bullosa. Clin Exp Dermatol. 2013;38:92-4.	7	Inherited forms of epidermolysis bullosa	Tetracyclines	Overall improvement	No funding sources reported.
			Oxytetracycline	Prevention of new lesions
			Aluminium chloride hexahydrate solution	Pain and pruritus
			Aluminium chloride hexahydrate solution	Quality of life
			Bufexamac cream	Expression of COL7A1 mRNA, type 7 collage
			Phenytoin	Anchoring fibrils
			Cultured allogeneic fibroblasts	Number and characteristics of lesions
			Trimethoprim	Number and characteristics of lesions
				Patient perception
				Number of infection
				Emergence of resistant bacteria
Majumdar 2002²⁷27 Majumdar S, Mockenhaupt M, Roujeau J, Townshend A. Interventions for toxic epidermal necrolysis. Cochrane Database Syst Rev. 2002;CD001435.	1	Toxic epidermal necrolysis	Thalidomide	Mortality	No funding sources reported.
				Quality of life
				Pain during acute episode
				Loss of total body surface area
				Serious infection
				Renal failure
				Length of hospital stay
				Bone marrow toxicity
Martin 2009²⁸28 Martin LK, Werth V, Villanueva E, Segall J, Murrell DF. Interventions for pemphigus vulgaris and pemphigus foliaceus. Cochrane Database Syst Rev. 2009;CD006263.	11	Pemphigus vulgaris and pemphigus foliaceus	Prednisolone	Remission	No funding sources reported.
			Dexamethasone	Mortality
			Azathioprine	Disease control
			Cyclophosphamide	Relapse
			Cyclosporine	Change in pemphigus severity score
			Dapsone	Change in pemphigus severity score
			Mycophenolate	Time to disease control
			Plasma exchange	Cumulative glucocorticoid dose
			Topical epidermal growth factor	Reduction of serum antibody titres
			Traditional Chinese medicine	Adverse events
			Traditional Chinese medicine	Quality of life
Singh 2011²⁹29 Singh S. Evidence-based treatments for pemphigus vulgaris, pemphigus foliaceus, and bullous pemphigoid: a systematic review. Indian J Dermatol Venereol Leprol. 2011;77:456-69.	19	Pemphigus vulgaris, pemphigus foliaceus, and bullous pemphigoid	Prednisolone	Adverse Events	No funding sources reported.
			Methylprednisolone	Overall improvement
			Dexamethasone	Remission
			Cyclophosphamide
			Dapsone
			Intravenous immunoglobulin
			Mycophenolate mofetil
			Cyclosporine
			Azathioprine
Zhao 2015³⁰30 Zhao CY, Murrell DF. Pemphigus vulgaris: an evidence-based treatment update. Drugs. 2015;75;271-84.	18	Pemphigus vulgaris	Mycophenolate mofetil	Mortality	No funding sources reported.
			Azathioprine	Disease control
			Intravenous immunoglobulins	Relapse
			Sulfasalazine	Withdrawal due to adverse events
			Pentoxifylline
			Infliximab
			Epidermal growth factor
			Pimecrolimus

Included systematic reviews	Bullous Diseases	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	Overall assessment
Asilian 2021²²22 Asilian A, Safaei H, Iraji F, Fatemi Naeini F, Faghihi G, Mokhtari F. Interventions for bullous pemphigoid: An updated systematic review of randomized clinical trials. Med J Islam Repub Iran. 2021;35:111.	BP	Y	N	N	N	Y	Y	N	Y	N	N	NA	NA	N	N	NA	Y	Critially Low quality
Atzmony 2014²³23 Atzmony L, Hodak E, Gdalevich M, Rosenbaum O, Mimouni D. Treatment of pemphigus vulgaris and pemphigus foliaceus: a systematic review and meta-analysis. Am J Clin Dermatol. 2014;15:503-15.	PV, PF	Y	N	N	N	Y	Y	N	Y	Y	N	Y	N	N	Y	N	Y	Critially Low quality
Atzmony 2015²⁴24 Atzmony L, Hodak E, Leshem YA, Rosenbaum O, Gdalevich M, Anhalt GJ, et al. The role of adjuvant therapy in pemphigus: A systematic review and meta-analysis. J Am Acad Dermatol. 2015;73:264-71.	PV, PF	Y	Y	N	PY	Y	Y	N	Y	Y	N	Y	Y	Y	Y	Y	Y	Low quality
Kirtschig 2010²⁵25 Kirtschig G, Middleton P, Bennett C, Murrell DF, Wojnarowska F, Khumalo NP. Interventions for bullous pemphigoid. Cochrane Database Syst Rev. 2010;CD002292.	BP	Y	Y	N	Y	Y	Y	Y	Y	Y	N	NA	NA	Y	Y	NA	Y	Moderate quality
Garcia-Doval 2013²⁶26 Garcia-Doval I, Davila-Seijo P, Langan SM. Updated systematic review of randomized controlled trials of treatments for inherited forms of epidermolysis bullosa. Clin Exp Dermatol. 2013;38:92-4.	EB	Y	N	N	PY	N	N	N	Y	PY	N	NA	NA	N	N	NA	Y	Critially Low quality
Majumdar 2002²⁷27 Majumdar S, Mockenhaupt M, Roujeau J, Townshend A. Interventions for toxic epidermal necrolysis. Cochrane Database Syst Rev. 2002;CD001435.	TEN	Y	Y	N	PY	Y	N	Y	Y	Y	N	NA	NA	Y	Y	NA	Y	Moderate quality
Martin 2009²⁸28 Martin LK, Werth V, Villanueva E, Segall J, Murrell DF. Interventions for pemphigus vulgaris and pemphigus foliaceus. Cochrane Database Syst Rev. 2009;CD006263.	PV, PF	Y	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	High quality
Singh 2011²⁹29 Singh S. Evidence-based treatments for pemphigus vulgaris, pemphigus foliaceus, and bullous pemphigoid: a systematic review. Indian J Dermatol Venereol Leprol. 2011;77:456-69.	PV, PF, BP	Y	N	N	PY	N	N	N	Y	Y	N	NA	NA	N	N	NA	N	Critially Low quality
Zhao 2015³⁰30 Zhao CY, Murrell DF. Pemphigus vulgaris: an evidence-based treatment update. Drugs. 2015;75;271-84.	PV	Y	N	N	PY	N	N	N	Y	N	N	NA	NA	N	N	NA	Y	Critially Low quality

[1] ⋆
Study conducted at the Universidade Metropolitana de Santos, Santos, SP, Brazil.

Brasil

Brasil

Quality of systematic reviews on the treatment of vesiculobullous skin diseases. A meta-epidemiological study^* ⋆ Study conducted at the Universidade Metropolitana de Santos, Santos, SP, Brazil.

Abstract

Background

Objective

Methods

Results

Conclusions

Brasil

Brasil

Quality of systematic reviews on the treatment of vesiculobullous skin diseases. A meta-epidemiological study* ⋆ Study conducted at the Universidade Metropolitana de Santos, Santos, SP, Brazil.

Abstract

Background

Objective

Methods

Results

Conclusions

Quality of systematic reviews on the treatment of vesiculobullous skin diseases. A meta-epidemiological study^* ⋆ Study conducted at the Universidade Metropolitana de Santos, Santos, SP, Brazil.