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NG198 Evidence Review F2

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NG198 Evidence Review F2 FINAL Management options for moderate to severe acne – pairwise comparisons 1 2 3 Review protocol for review question: For people with moderate to severe acne vulgaris what are the best treatment 4 options of those covered in 9 review questions? 5 A single review protocol and literature search was used to identify randomised trials of treatments for acne. Outcomes were prioritised for either 6 pairwise or network meta-analysis (NMA) and the evidence was divided according to the severity of acne into mild to moderate and moderate 7 to severe categories. The evidence was then summarised in four separate reviews covering the treatment of: 8 • mild to moderate acne (NMA) 9 • mild to moderate acne (pairwise meta-analysis) 10 • moderate to severe acne (NMA) 11 • moderate to severe acne (pairwise meta-analysis) 12 Table 3: Review protocol Field Content PROSPERO registration CRD42020154100 number Review title Comparative effectiveness, acceptability and tolerability of topical or oral pharmacological and physical interventions in the treatment of acne vulgaris: a systematic review using network and pairwise meta-analysis Review question 2.1 What is the effectiveness of topical treatments individually or in combination in the treatment of acne vulgaris? 3.1 What is the effectiveness of oral antibiotic treatments in the treatment of acne vulgaris? 4.1 What is the effectiveness of combining an oral antibiotic with a topical agent compared to an oral antibiotic alone in the treatment of acne vulgaris? 5.1 What is the optimal duration of antibiotic treatments (topical and systemic) for acne vulgaris? 6.1 What is the effectiveness of oral hormonal contraceptives in the treatment of acne vulgaris? Acne vulgaris: evidence reviews for management options for moderate to severe acne – pairwise comparisons FINAL (June 2021) 42 FINAL Management options for moderate to severe acne – pairwise comparisons Field Content 6.2 What is the effectiveness of non- hormonal contraceptive anti-androgens (including spironolactone) in the treatment of acne vulgaris? 6.3 What is the effectiveness of metformin in the treatment of acne vulgaris? 8.1 What is the effectiveness of oral isotretinoin in the treatment of acne vulgaris? 9.1 What is the effectiveness of physical treatments for acne vulgaris? Objective The objective of this review is to establish which topical or oral pharmacological and physical interventions are effective, acceptable and tolerable in the treatment of acne vulgaris. Searches • The following databases will be searched: • Cochrane Central Register of Controlled Trials (CENTRAL) • Cochrane Database of Systematic Reviews (CDSR) • Embase • MEDLINE Searches will be restricted by: • Date: No restriction • Language of publication: English language only • Publication status: Conference abstracts will be excluded because these do not typically provide sufficient information to fully assess risk of bias. Unpublished data will also be excluded. • Standard exclusions filter (animal studies/low level publication types) will be applied • For each search, the principal database search strategy is quality assured by a second information specialist using an adaption of the PRESS 2015 Guideline Evidence-Based Checklist Other search methods will involve scanning the reference lists of all eligible systematic reviews for published studies meeting inclusion criteria. Condition or domain being Acne vulgaris studied Population Inclusion: People with acne vulgaris, of all ages and levels of symptom severity. Studies need to provide data specific to people with mild to moderate acne, and/or people with moderate to severe acne. See under ‘Analysis of sub-groups’ for the approach followed in order to categorise population in the studies into mild to moderate acne or moderate to severe acne. Acne vulgaris: evidence reviews for management options for moderate to severe acne – pairwise comparisons FINAL (June 2021) 43 FINAL Management options for moderate to severe acne – pairwise comparisons Field Content All settings (community, primary, secondary, and tertiary health care) will be considered. Exclusions: • Neonatal acne • People with post-inflammatory dyspigmentation • Trials recruiting specifically people with acne vulgaris and polycystic ovary syndrome (PCOS) • Trials of maintenance treatment (‘relapse prevention’ trials), which recruit people currently in remission or people who have responded to treatment or who have had successful treatment or who are reported to have received primary or ‘acute’ treatment immediately prior to randomisation to maintenance treatment. • Trials that have specifically recruited people who have not responded to previous treatment (refractory or resistant acne) for the same episode of acne; however, trials of people with recurrent or persistent acne, who are treated for a new episode of acne, will be included • Trials that include all ranges of severity • Trials with indirect population: Where studies with a mixed population (i.e. include people with acne vulgaris and another condition, e.g. hirsutism) are identified, those with <66% of the relevant population will be excluded, unless subgroup analysis for acne vulgaris is reported. Intervention Interventions will be categorised into the following classes, and, if relevant, subclasses (the list is non-exhaustive): TOPICAL TREATMENTS Abrasive/cleaning agents • Aluminium oxide [own class] Anthelmintics • Cysticide (praziquantel) [own class] • Class of avermectins: ivermectin Antibacterials • Class of triclocarban and triclozan Antibiotics Acne vulgaris: evidence reviews for management options for moderate to severe acne – pairwise comparisons FINAL (June 2021) 44 FINAL Management options for moderate to severe acne – pairwise comparisons Field Content • Class of sulphones (dapsone) • Fusidic acid (sodium fusidate) [own class] • Class of lincosamides (for example clindamycin) • Class of macrolides (for example clarithromycin, erythromycin with zinc acetate dihydrate) • Class of nitroimidazoles (metronidazole) • Class of carboxylic acids (mupirocin) • Class of penicillins o Sub-class of natural (for example almecillin) o Sub-class of aminopenicillins (for example ampicillin) o Sub-class of β-lactamase-resistant (for example methicillin) o Sub-class of carboxypenicillins (for example ticarcillin) o Sub-class of ureidopenicillins (for example azlocillin) o Sub-class of other penicillins (mecillinam, pivmecillinam hydrochloride) • Class of pleuromutilins (for example retapamulin) Antiseptics • Benzoyl peroxide (trade: Acnecide, Brevoxyl, Panoxyl) [own class] • Chlorhexidine gluconate (trade: Acnemed, Cepton) or digluconate [own class] Dicarboxylic acids • Azelaic acid [own class] Vitamin B3 • Nicotinamide (niacinamide) [own class] Retinoids or retinoid-like agents • Class of retinoids or retinoid-like agents (adapalene, isotretinoin, retinol, tazarotene, tretinoin) Combined interventions • Benzoyl peroxide & potassium hydroxyguinoline sulfate [own class] • Class of benzoyl peroxide & retinoid (benzoyl peroxide + adapalene) • Class of benzoyl peroxide & lincosamide (benzoyl peroxide + clindamycin) • Class of lincosamides & retinoid (clindamycin + tretinoin) Acne vulgaris: evidence reviews for management options for moderate to severe acne – pairwise comparisons FINAL (June 2021) 45 FINAL Management options for moderate to severe acne – pairwise comparisons Field Content • Class of macrolides & retinoid (erythomycin + retinoid) [topical] • Germolene (phenol 1.2% + chlorhexidine diculconate [own class] ORAL ANTIBIOTICS • Class of carbapenems (for example imipenem, meropenem) • Class of carbapenems with cilastatin (imipenem with cilastatin) • Class of carbapenems with b lactamase inhibitor (meropenem with vaborbactam) • Class of cephamycins/cephalosporins st o Sub-class of 1 -generation (for example cefadroxil) nd o Sub-class of 2 -generation (for example cefaclore) rd o Sub-class of 3 -generation (for example cefdinir) th o Sub-class of 4 -generation (for example cefozopran) th o Sub-class of 5 -generation (for example ceftolozane) • Class of cephamycins/cephalosporins with β-lactamase inhibitor (for example ceftraroline or ceftazidime with avibactam, cefoperazone with sulbactam, ceftolozane with tazobactam) • Class of sulphones (dapsone) • Fusidic acid (sodium fusidate) [own class] • Class of lincosamides (for example clindamycin) • Class of macrolides (for example clarithromycin, erythromycin) • Class of monobactams (aztreonam) • Class of monobactams with β-lactamase inhibitor (aztreonam with avibactam) • Class of penicillins o Sub-class of natural (for example almecillin) o Sub-class of aminopenicillins (for example ampicillin) o Sub-class of β-lactamase-resistant (for example methicillin) o Sub-class of carboxypenicillins (for example ticarcillin) o Sub-class of ureidopenicillins (for example azlocillin) o Sub-class of other penicillins (mecillinam, pivmecillinam hydrochloride) • Class of penicillin with β-lactamase inhibitor (for example co-amoxiclav [amoxicillin with clavulanic acid], piperacillin with tazobactam, ticaricillin with clavulanic acid, sultamicillin [ampicillin with sulbactam]) • Class of penicillin with flucloxacilin (co-fluampicil [ampicillin + flucloxacilin]) • Class of pleuromutilins (for example retapamulin) Acne vulgaris: evidence reviews for management options for moderate to severe acne – pairwise comparisons FINAL (June 2021) 46 FINAL Management options for moderate to severe acne – pairwise comparisons Field Content • Class of quinolones st o Sub-class of
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