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An arm-based network meta-analysis on treatments for vulvar lichen sclerosus and a call for development of core outcome sets.

Abstract：

OBJECTIVE:The purpose of the present systematic review is to evaluate the available medical treatments for vulvar lichen sclerosus, using an arm-based network meta-analysis protocol. DATA SOURCES:We searched Medline (1966-2019), Scopus (2004-2019), Cochrane Central Register of Controlled Trials CENTRAL (1999-2019), Clinicaltrials.gov (2008-2019) databases, and Google Scholar (2004-2019) database along with the reference list of all included studies. STUDY ELIGIBILITY CRITERIA:All observational, randomized, and single-arm studies that evaluated medical treatments for vulvar lichen sclerosus were considered eligible for inclusion in the present systematic review. STUDY APPRAISAL:A network meta-analysis was carried out in R 3.4.3 using the pcnetmeta package, which uses a Bayesian hierarchical model (based in Markov chain Monte Carlo convergence simulation). RESULTS:Sixteen studies were included in this present meta-analysis, which recruited 954 women with vulvar lichen sclerosus. Their quality was evaluated with the JADAD, Cochrane risk of bias, and risk of bias in nonrandomised studies of interventions-I tools. Clobetasol treatment ranked as the best treatment for disease remission after evaluating rank probabilities (40% chance of ranking first compared with tacrolimus [38%]). However, the density plot revealed partial overlapping with tacrolimus. The lowest probability of experiencing a relapse was observed with pimecrolimus (15% [2-48%]); however, the density plot revealed significant overlapping with mometasone furoate, testosterone, and clobetasol. CONCLUSION:Robust evidence concerning the superiority of potent steroids at least over calcineurin inhibitors is still lacking in the field of vulvar lichen sclerosus. On the other hand, the gross heterogeneity in terms of selected population, duration of treatment, administered regimen, outcome reporting, and selection of outcome measures leaves several fields unanswered.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Pergialiotis V,Bellos I,Biliou EC,Varnava P,Mitsopoulou D,Doumouchtsis SK,CHORUS, an International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health (i-chorus.org).

doi

10.1016/j.ajog.2019.10.095

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

542-550.e6

issue

eissn

0002-9378

issn

1097-6868

pii

S0002-9378(19)31321-3

journal_volume

222

pub_type

杂志文章

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An arm-based network meta-analysis on treatments for vulvar lichen sclerosus and a call for development of core outcome sets.