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Drucker AM, Lam M, Elsawi R, Prieto-Merino D, Malek R, Ellis AG, Yiu ZZN, Rochwerg B, Di Giorgio S, Arents BWM, Burton T, Spuls PI, Schmitt J, Flohr C. Comparing binary efficacy outcomes for systemic immunomodulatory treatments for atopic dermatitis in a living systematic review and network meta-analysis. Br J Dermatol 2024; 190:184-190. [PMID: 37831594 DOI: 10.1093/bjd/ljad393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Systemic treatments for atopic dermatitis (AD) are evaluated primarily in placebo-controlled trials with binary efficacy outcomes. In a living systematic review and network meta-analysis (NMA), we previously analysed continuous efficacy measures. OBJECTIVES To compare binary efficacy outcomes of systemic treatments for AD. METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Latin American and Caribbean Health Science Information (LILACS) database, Global Resource for Eczema Trials (GREAT) database and trial registries up to 1 March 2023. We included randomized trials examining ≥ 8 weeks of treatment with systemic immunomodulatory medications for moderate-to-severe AD. We screened titles, abstracts and full texts and abstracted data independently, in duplicate. Outcomes included the proportion of patients achieving at least 50%, 75% and 90% improvements in Eczema Area and Severity Index (EASI 50, EASI 75 and EASI 90, respectively) and Investigator Global Assessment (IGA) success. We performed random-effects Bayesian NMAs to calculate odds ratios (OR) and 95% credible intervals (CrIs) between each intervention for each outcome. RESULTS Eighty-three trials with 22 122 participants were included in the systematic review. In analyses limited to trials of 8-16 weeks' duration with predominantly adult populations, abrocitinib 200 mg daily (OR 1.5, 95% CrI 1.1-2.2) and upadacitinib 15 mg daily (OR 1.7, 95% CrI 0.9-3.3) and 30 mg daily (OR 2.5, 95% CrI 1.3-5.0) were associated with higher odds of achieving EASI 50 vs. dupilumab. Abrocitinib 100 mg daily (OR 0.7, 95% CrI 0.5-1.0), baricitinib 2 mg daily (OR 0.4, 95% CrI 0.3-0.5) and 4 mg daily (OR 0.5, 95% CrI 0.3-0.7), and tralokinumab (OR 0.4, 95% CrI 0.3-0.6) were associated with lower odds of achieving EASI 50 vs. dupilumab. Results were similar for EASI 75, EASI 90 and IGA success. CONCLUSIONS Supporting results for continuous outcome measures, upadacitinib 30 mg daily and abrocitinib 200 mg daily are the most efficacious with regard to binary efficacy endpoints up to 16 weeks in adults with moderate-to-severe AD, followed by upadacitinib 15 mg daily, dupilumab and abrocitinib 100 mg daily. Dupilumab and both doses of upadacitinib and abrocitinib are more efficacious than baricitinib 4 and 2 mg daily and tralokinumab.
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Affiliation(s)
- Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto and Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Megan Lam
- Division of Dermatology, Department of Medicine, University of Toronto and Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Rawaan Elsawi
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Rayka Malek
- School of Life Course and Population Health Sciences, King's College London, London, UK
| | | | - Zenas Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Bram Rochwerg
- Departments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Bernd W M Arents
- Dutch Association for People with Atopic Dermatitis (VMCE), Nijkerk, the Netherlands
| | - Tim Burton
- Patient Representative (independent), Nottingham, UK
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam, the Netherlands
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Carsten Flohr
- Unit for Paediatric and Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London, London, UK
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Music M, Elsawi R, Li C, Tang E, Wang R, Jia J, Lee D, Liu A. Canadian patient attitudes toward virtual dermatology care. JAAD Int 2023; 13:56-59. [PMID: 37692974 PMCID: PMC10483039 DOI: 10.1016/j.jdin.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Affiliation(s)
- Milena Music
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rawaan Elsawi
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Calandra Li
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Evan Tang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Wang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jocelyn Jia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Elsawi R, Drucker A, Dainty K, Wu W, Butler L, Capozza K, Eftekhari S, Tullos KT, Begolka WS. 33184 The variable burden and impact of atopic dermatitis: A multi-method analysis of the More Than Skin Deep survey. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elsawi R, Dainty K, Smith Begolka W, Barta K, Butler L, Capozza K, Eftekhari S, Tullos KZ, Wu W, Drucker AM. The Multidimensional Burden of Atopic Dermatitis Among Adults: Results From a Large National Survey. JAMA Dermatol 2022; 158:887-892. [PMID: 35767267 PMCID: PMC9244770 DOI: 10.1001/jamadermatol.2022.1906] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Atopic dermatitis (AD) is long term and burdensome. Studies investigating disease burden in adults are limited in scope with gaps in understanding of the adult patient lived experience. Objective To describe the multidimensional burden of AD among mainly US adults. Design, Setting, and Participants This survey study for an externally led patient-focused drug development meeting with the US Food and Drug Administration on adult patients with AD was conducted between August 1, 2019, and October 11, 2019. Data were analyzed betwean March 26, 2021, and June 29, 2021. Main Outcomes and Measures We used multivariable ordinal regression to assess associations between demographic and clinical variables and patient-reported overall AD impact scores (ordinal scale from 1 [no impact] to 5 [significant impact]). Results Among 1065 survey respondents, 114 (11%) were aged 18 to 24 years, 235 (22%) were 25 to 34 years, 242 (23%) were 35 to 50 years, 288 (27%) were 51 to 64 years, and 186 (17%) were aged 65 years or older; 881 (83%) were women. Four hundred eighty-nine (46%) participants reported low-moderate AD impact scores (2-3), 544 (51%) reported high-significant impact scores (4-5), whereas 32 (3%) reported no association of AD with disease burden (impact score, 1). Variables strongly associated with overall impact scores were current AD severity (moderate: OR, 4.13; 95% CI, 2.94-5.79; severe: OR, 13.63; 95% CI, 8.65-21.50 vs mild), and time spent managing AD (11-20 hours: OR, 2.67; 95% CI, 1.77-4.03, ≥21 hours: OR, 5.34; 95% CI, 3.22-8.85, vs <5 hours). Conclusions and Relevance In this survey study, AD severity and time spent managing symptoms showed the strongest associations with disease burden. This analysis highlights the multidimensional burden of AD in adults and emphasizes the need for more effective treatment strategies that reduce the time patients spend managing their AD.
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Affiliation(s)
- Rawaan Elsawi
- Temerty Faculty of Medicine, University of Toronto and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Katie Dainty
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,North York General Hospital, North York, Ontario, Canada
| | | | | | - Lisa Butler
- National Eczema Association, Novato, California
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, California
| | - Sanaz Eftekhari
- Asthma and Allergy Foundation of America, Arlington, Virginia
| | - Kathryn Z Tullos
- International Topical Steroid Awareness Network, Dacula, Georgia
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Aaron M Drucker
- Temerty Faculty of Medicine, University of Toronto and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Croitoru D, Seigel K, Nathanielsz N, Elsawi R, Silverberg MS, Piguet V, Sibbald C. Treatment of Severe Hidradenitis Suppurativa and Fistulizing Crohn’s Disease with Guselkumab. J Eur Acad Dermatol Venereol 2022; 36:e563-e565. [DOI: 10.1111/jdv.18033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/24/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- David Croitoru
- Division of Dermatology Department of Medicine University of Toronto Toronto Ontario Canada
| | - Kyle Seigel
- Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada
| | - Nikki Nathanielsz
- Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada
| | - Rawaan Elsawi
- Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada
| | - Mark S Silverberg
- Division of Gastroenterology Department of Medicine Mount Sinai Hospital University of Toronto Toronto Ontario Canada
| | - Vincent Piguet
- Division of Dermatology Department of Medicine University of Toronto Toronto Ontario Canada
- Division of Dermatology Department of Medicine Women’s College Hospital Toronto Ontario Canada
| | - Cathryn Sibbald
- Division of Dermatology Department of Medicine University of Toronto Toronto Ontario Canada
- Section of Dermatology Department of Pediatrics The Hospital for Sick Children Toronto Ontario Canada
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Seigel K, Croitoru D, Nathanielsz N, Elsawi R, Silverberg MS, Sibbald C, Piguet V. Clinical Features and Treatment Outcomes in Hidradenitis Suppurativa With Fistulizing Crohn’s Disease: A Systematic Review. J Cutan Med Surg 2022; 26:426-427. [DOI: 10.1177/12034754221083980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kyle Seigel
- Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - David Croitoru
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | | | - Rawaan Elsawi
- Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Mark S. Silverberg
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, Women’s College Hospital, Toronto, ON, Canada
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Elsawi R, Brooks SG, Georgakopolous JR, Lansang P, Piguet V, Croitoru D. The Utility of IL-17 Inhibitors in Neutrophilic Dermatoses: A Systematic Review. J Cutan Med Surg 2021; 26:210-211. [PMID: 34498508 DOI: 10.1177/12034754211045389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rawaan Elsawi
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | | | - Jorge R Georgakopolous
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada.,12366 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Perla Lansang
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada.,12366 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Sunnybrook Hospital, Toronto, ON, Canada
| | - Vincent Piguet
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada.,12366 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | - David Croitoru
- 12366 Temerty Faculty of Medicine, University of Toronto, ON, Canada.,12366 Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
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Vancolen SY, Elsawi R, Horner NS, Leroux T, Alolabi B, Khan M. Reverse total shoulder arthroplasty in the younger patient (≤65 years): a systematic review. J Shoulder Elbow Surg 2020; 29:202-209. [PMID: 31492619 DOI: 10.1016/j.jse.2019.06.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to evaluate outcomes of reverse total shoulder arthroplasty (RTSA) in patients aged ≤65 years. MEDLINE, Embase, and PubMed were searched for relevant studies from database inception to September 18, 2018. All studies that evaluated RTSA in patients aged ≤65 years were included. Two independent reviewers screened all studies and performed a quality assessment. In the total of 6 studies reviewed, 245 participants underwent RTSA, with the most common indications being failed rotator cuff repair and rotator cuff tear arthropathy. Postoperative functional outcomes indicated a significant level of improvement across all reported outcomes at a mean follow-up of 49 months (range, 19-140 months) (P < .05). The pooled mean complication rate was 18% (n = 44/245), and this higher rate may be due to 36% of patients undergoing an RTSA for a failed arthroplasty procedure and the inclusion of older studies that lacked modern implants and techniques. Although there is a significant improvement in functional outcomes at midterm follow-up for RTSA in the patients aged ≤65 years, the pooled complication rates are high. However, the results of this systematic review are limited because of the heterogenous patient population undergoing surgery for various indications, including revision arthroplasty. Long-term studies and registry data are required using current modern techniques and implants to provide an accurate assessment of outcomes following RTSA in a young patient population.
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Affiliation(s)
| | | | - Nolan S Horner
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
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