Fluocinonide 0.05% compared with hydrocortisone 1% for discoid lupus erythematosus

Patient or population: people with discoid lupus erythematosus

Settings: not stated

Intervention: fluocinonide

Comparison: hydrocortisone

Clearing or excellent improvement

(after 6 weeks of treatment)

2.77 (0.95 to 8.08)

78

(1 study)

Low¹

‐

At least 50% reduction in erythema

see comment

see comment

see comment

This outcome was not assessed.

Quality of life measure

see comment

see comment

see comment

This outcome was not assessed.

Relapse

see comment

see comment

see comment

This outcome was not assessed.

Adverse events of medication, leading to discontinuation or significant morbidity

see comment

78

(1 study)

Moderate²

The number of adverse events in this study was small and results were presented narratively. For hydrocortisone, 1 person developed acne and 3 experienced irritation. 2 patients who were assigned to fluocinonide experienced burning. There was no discontinuation in either group.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk Ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Acitretin 50 mg daily compared with hydroxychloroquine 400 mg daily for discoid lupus erythematosus

Patients or population: people with discoid lupus erythematosus

Settings: specialised lupus clinic

Intervention: acitretin

Comparison: hydroxychloroquine

Clearing or excellent improvement

(after 8 weeks of treatment)

0.93 (0.54 to 1.59)

58

(1 study)

Low¹

‐

At least 50% reduction in erythema

(after 8 weeks of treatment)

0.61 (0.36 to 1.06)

49

(1 study)

Low¹

‐

Quality of life measure

see comment

see comment

see comment

This outcome was not assessed.

Relapse

see comment

see comment

see comment

This outcome was not assessed.

Adverse events of medication, leading to discontinuation or significant morbidity

see comment

58

(1 study)

Moderate²

Information on adverse events was presented narratively. 27 out of 28 participants receiving acitretin had at least one adverse event compared with 17 out of 30 patients treated with hydroxychloroquine. 4 people receiving acitretin discontinued treatment due to dry lips and gastrointestinal symptoms.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk Ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Pimecrolimus 1% compared with betamethasone 17‐valerate 0.1% for discoid lupus erythematosus

Patients or population: people with discoid lupus erythematosus

Settings: dermatology clinics

Intervention: pimecrolimus

Comparison: betamethasone

Clearing or excellent improvement

(after 8 weeks of treatment)

10

(1 study)

see comment

There was a statistically significant reduction in the disease severity score in both treatment groups; however, clearing or improvement was not presented as a percentage and no comparative analyses were performed.

At least 50% reduction in erythema

see comment

see comment

This outcome was not assessed.

Quality of life measure

see comment

see comment

This outcome was not assessed.

Relapse

see comment

see comment

This outcome was not assessed.

Adverse events of medication, leading to discontinuation or significant morbidity

see comment

see comment

This outcome was not assessed.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk Ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

R‐salbutamol 0.5% topical cream compared with placebo for discoid lupus erythematosus

Patient or population: people with discoid lupus erythematosus

Settings: dermatology departments

Intervention: R‐salbutamol

Comparison: placebo

Clearing or excellent improvement

37

(1 study)

see comment

While data on overall improvement were provided in the study, the number of participants with complete resolution in Jemec 2009 could not be obtained from the trial report.

At least 50% reduction in erythema

37

(1 study)

see comment

While data on erythema were provided in the study report, the number of participants with at least 50% reduction in erythema in Jemec 2009 could not be obtained from the trial report.

Quality of life measure

see comment

see comment

This outcome was not assessed.

Relapse

see comment

see comment

This outcome was not assessed.

Adverse events of medication, leading to discontinuation or significant morbidity

37

(1 study)

Moderate¹

Results for adverse events were presented narratively. There were 15 events in the placebo group (experienced by 12 participants) and 24 in the salbutamol group (experienced by 9 participants). None of the adverse events were considered serious.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk Ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

Tacrolimus 0.1% cream compared with placebo for discoid lupus erythematosus

Patient or population: people with discoid lupus erythematosus

Settings: dermatology departments

Intervention: tacrolimus

Comparison: placebo

Clearing or excellent improvement

see comment

see comment

No participants with DLE in either group in the study by Kuhn 2011 experienced complete clearing. Unable to GRADE due to 0 events in both groups.

At least 50% reduction in erythema

see comment

see comment

The results for erythema in the study by Kuhn 2011 were not reported separately.

Quality of life measure

see comment

see comment

This outcome was not measured.

Relapse

see comment

see comment

This outcome was not measured.

Adverse events of medication, leading to discontinuation or significant morbidity

14

(1 study)

Moderate¹

Results for adverse events were presented narratively. In the tacrolimus group, 5 participants complained of slight burning and itching, and in 1 person a herpes simplex infection was reactivated. There were no serious adverse events.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.