Pairwise Comparisons

National Institute for Health and Care Excellence Final Acne vulgaris: management [E2] Management options for mild to moderate acne – pairwise comparisons NG198 Evidence review underpinning recommendations 1.5.1, 1.5.2 and 1.5.5 to 1.5.14 (excluding 1.5.6 which is underpinned by evidence review L, 1.5.10 and bullet points 2 and 3 of recommendation 1.5.12 which are underpinned by evidence review F1 and 3 research recommendations in the NICE guideline - see evidence review E1 for the committee’s discussion of the evidence) June 2021 Final These evidence reviews were developed by the National Guideline Alliance which is a part of the Royal College of Obstetricians and Gynaecologists FINAL Error! No text of specified style in document. Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. 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ISBN: 978-1-4731-4147-6 FINAL Contents Summary of review questions covered in this report ....................................................... 6 Management options for mild to moderate acne – pairwise comparisons ....................... 8 Review question ............................................................................................................. 8 Introduction ........................................................................................................... 8 Summary of the protocol ....................................................................................... 8 Methods and process .......................................................................................... 11 Clinical evidence ................................................................................................. 12 Summary of included studies ............................................................................... 14 Quality assessment of included studies in the evidence review ........................... 34 Economic evidence ............................................................................................. 34 Economic model .................................................................................................. 35 The committee’s discussion of the evidence ........................................................ 35 Recommendations supported by this evidence review ........................................ 35 References .......................................................................................................... 35 Appendices ........................................................................................................................ 43 Appendix A - Review protocol ............................................................................... 43 Review protocol for review question: For people with mild to moderate acne vulgaris what are the best treatment options of those covered in 9 review questions? .................................................................................... 43 Appendix B - Literature search strategies ............................................................. 66 Literature search strategies for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? ............................... 66 Clinical search ..................................................................................................... 66 Health Economics search .................................................................................... 78 Appendix C - Clinical evidence study selection ..................................................... 81 Clinical study selection for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? ............................... 81 Appendix D - Evidence tables ............................................................................... 82 Evidence tables for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? ............................... 82 Appendix E - Forest plots.................................................................................... 155 Forest plots for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? ................................................. 155 Appendix F - GRADE tables ............................................................................... 163 GRADE tables for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? ................................................. 163 Appendix G - Economic evidence study selection ............................................... 187 4 FINAL Economic evidence study selection for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? 187 Appendix H - Economic evidence tables ............................................................. 188 Economic evidence tables for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? ............................. 188 Appendix I - Economic evidence profiles ................................................................. 189 Economic model for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? ............................. 189 Appendix J - Economic analysis ......................................................................... 190 Appendix K - Excluded studies ........................................................................... 191 Excluded clinical and economic studies for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? 191 Clinical studies .................................................................................................. 191 Economic studies and studies reporting utility data ........................................... 272 Appendix L - Research recommendations .......................................................... 275 Research recommendations for review question: What is the effectiveness and acceptability of interventions for the treatment of mild to moderate acne (side effects and participant reported improvement)? .................... 275 5 FINAL Management options for mild to moderate acne – pairwise comparisons 1 Summary of review questions covered in 2 this report 3 A single review protocol and literature search was used to identify randomised trials of 4 treatments for acne vulgaris to address 9 review questions covering topical or oral 5 pharmacological treatments and physical treatments, shown below. Outcomes were 6 prioritised for either pairwise or network meta-analysis (NMA) and the evidence was divided 7 according to the severity of acne into mild to moderate and moderate to severe categories. 8 NMA was employed to assess comparative efficacy, acceptability and tolerability of 9 treatments, which are outcomes commonly reported in the literature for the majority of 10 treatments. Pairwise meta-analysis was used to synthesise outcomes for which evidence 11 was more limited across treatments or was treatment-specific. The evidence was then 12 summarised in four separate reviews covering the treatment of: 13 • mild to moderate acne (NMA) 14 • mild to moderate acne (pairwise meta-analysis) 15 • moderate to severe acne (NMA) 16 • moderate to severe acne (pairwise meta-analysis) 17 This evidence review contains information on the pairwise meta-analyses conducted to

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