Drugs for discoid lupus erythematosus

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dc.contributor.authorJessop S.
dc.contributor.authorWhitelaw D.A.
dc.contributor.authorDelamere F.M.
dc.date.accessioned2011-05-15T16:01:26Z
dc.date.available2011-05-15T16:01:26Z
dc.date.issued2009
dc.description.abstractBackground: Discoid lupus erythematosus is a chronic formof cutaneous (skin) lupus which can cause permanent scarring if treatment is inadequate. Many drugs have been used to treat this disease and some of these are potentially very toxic. Objectives: To assess the effects of drugs for discoid lupus erythematosus. Search strategy: In June 2009 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2, 2009), MEDLINE, EMBASE, LILACS, and online ongoing trials registers. The reference lists of relevant reviews were searched. Index Medicus (1956 to 1966) was handsearched and we approached authors for information about unpublished trials. Selection criteria: We included all randomised trials of drugs to treat people with discoid lupus erythematosus. Drugs included in the search were azathioprine, chloroquine, clofazimine, corticosteroids, (oral and topical), dapsone, gold, interferon alpha-2a, methotrexate, phenytoin, retinoids, sulphasalazine, thalidomide, topical calcineurin blockers (pimecrolimus and tacrolimus), and biological agents (etanercept,efalizimab, infliximab, and rituximab). Data collection and analysis: Two reviewers independently examined each retrieved study for eligibility. Main results: Two trials involving 136 participants were included. No new trials were included in this update. In a cross-over study of 12 weeks duration, fluocinonide 0.05% cream (a potent topical corticosteroid), appeared to be better than hydrocortisone 1% cream (a mild corticosteroid) when the first arm of the trial involving 78 participants was analysed at 6 weeks. Clearing or excellent improvement was seen in 27% of people using fluocinonide and in 10% of those using hydrocortisone, giving a 17% absolute benefit in favour of fluocinonide (95% CI 0.0 to 0.34, NNT (Number needed to treat) 6). In the second trial, acitretin (50mg/day) was compared with hydroxychloroquine (400mg/day) in 58 people in a parallel trial of 8 weeks duration. There was marked improvement or clearing in 46% of people using acitretin and in 50% of those on hydroxychloroquine but there was no significant difference between the 2 interventions. The adverse effects were more frequent and more severe in the acitretin group. In this trial clearing of erythema was measured and found to be better in the hydroxychloroquine group (RR 0.61, 95% CI 0.36 to 1.06). Authors' conclusions: Fluocinonide cream may be more effective than hydrocortisone in treating people with discoid lupus erythematosus. Hydroxychloroquine and acitretin appear to be of equal efficacy, although adverse effects are more frequent and more severe with acitretin. There is not enough reliable evidence about other drugs used to treat discoid lupus erythematosus. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
dc.description.versionReview
dc.identifier.citationCochrane Database of Systematic Reviews
dc.identifier.citation4
dc.identifier.issn1469493X
dc.identifier.other10.1002/14651858.CD002954.pub2
dc.identifier.urihttp://hdl.handle.net/10019.1/11976
dc.subjectetretin
dc.subjectfluocinonide
dc.subjecthydrocortisone
dc.subjecthydroxychloroquine
dc.subjectacne
dc.subjectcheilitis
dc.subjectclinical trial
dc.subjectcontrolled clinical trial
dc.subjectdiscoid lupus erythematosus
dc.subjectdisease severity
dc.subjectdrug effect
dc.subjectdrug efficacy
dc.subjectdrug withdrawal
dc.subjectgastrointestinal symptom
dc.subjecthuman
dc.subjectoutcome assessment
dc.subjectrandomized controlled trial
dc.subjectrating scale
dc.subjectrecommended drug dose
dc.subjectretinopathy
dc.subjectreview
dc.subjectscoring system
dc.subjectside effect
dc.subjectskin burning sensation
dc.subjectskin irritation
dc.subjectsystematic review
dc.subjecttriacylglycerol blood level
dc.subjectvisual impairment
dc.titleDrugs for discoid lupus erythematosus
dc.typeReview
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