Comparative efficacy of monotherapies for chronic hand eczema: A network meta-analysis study

Abstract

Chronic hand eczema (CHE) is a highly prevalent dermatology-related occupational hazard. This condition, which is a distinct diagnosis from atopic dermatitis (AD), can be quite symptomatic with implications for one's personal and professional life. Many therapeutic interventions exist for CHE, and the current study determined—through network meta-analyses (NMAs)—the relative efficacy of the newer treatments for CHE. Data for eligible studies were identified after systematically reviewing the literature in PubMed and Scopus. Eligible studies were those that had an arm investigating the impact of monotherapy on 12- or 16-week changes in Hand Eczema Severity Index (HECSI) scores. We conducted sensitivity analyses where network meta-regressions were performed to (ecologically) adjust for variation due to age and sex. Base and sensitivity analyses were adjusted for disease severity at baseline. Results: We identified 5 eligible studies—across which there were 10 active comparators. Among the active comparators were two treatments approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of CHE, namely, alitretinoin 30 mg once daily (oral) and delgocitinib 20 mg/g twice daily (topical). We estimated pairwise relative effects using the mean difference (i.e., mean reduction) in the respective HECSI scores; furthermore, efficacy was ranked with Surface Under the Cumulative Ranking Curve (SUCRA) values. We attempted to contribute to the existing CHE literature by producing comparative information on its treatments' relative efficacy; moreover, we found no published NMA study on available treatments for CHE before the conduct of our work. Our results can guide clinical decision-making.