Update information September 2017: The guideline has been revised throughout to link to MHRA advice and NICE technology appraisals that have been completed since original publication. Minor updates since publication August 2019: Links to the MHRA safety advice on the risk of using retinoids in pregnancy have been updated to the June 2019 version.
Search strategies used for the Psoriasis guideline were run in accordance with the NICE Guidelines Manual 2009: http://www.nice.org.uk/media/5F2/44/The_guidelines_manual_2009_-_All_chapters.pdf
All searches were run up to 08/03/2012 unless otherwise stated. Any studies added to the databases after this date were not included unless specifically stated in the text.
Clinical searches
Searches for clinical reviews were run in Medline (OVID), Embase (OVID), the Cochrane Library (Wiley) and CINAHL (EBSCO). Typically, searches were constructed in the following way:
- ➢
A PICO format was used for intervention searches. Population (P) terms were combined with Intervention (I) and sometimes Comparison (C) terms (as indicated in the tables under each individual question in Section A.3). An intervention can be a drug, a procedure or a diagnostic test. Outcomes (O) are rarely used in search strategies for interventions. Study type filters were added where appropriate (see A.1).
In addition to the databases outlined above, search A.3.14 and A.3.15 were run in PsycINFO (OVID). Where possible searches were limited to papers published in English. All search results retrieved on Cinahl were restricted to exclude Medline records.
Economic searches
Searches for economic evidence were run in Medline (Ovid), Embase (Ovid), the NHS Economic Evaluations Database (NHS EED), the Health Technology Assessment (HTA) database and the Health Economic Evaluation Database (HEED). NHS EED and HTA were searched via the Centre for Reviews and Dissemination (CRD) interface. For Medline and Embase an economic filter was added to the same clinical search strategy (see A.1.4). All other economic searches were conducted using only population terms.
D.1. Study design search terms
D.1.1. Systematic review (SR) search terms
D.1.6. Diagnostic accuracy
D.2. Standard population search strategy
D.3. Searches for specific questions
D.3.1. Assessment tools
- Q.
In people with psoriasis (all types), which are the most effective tools to assess the (a) severity and (b) impact of disease across all levels of healthcare provision and at any stage of the disease journey?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.2. Diagnostic tools for psoriatic arthritis
- Q.
In people with psoriasis (all types), which is the most accurate diagnostic tool compared with clinical diagnosis by a rheumatologist to help a non-specialist identify psoriatic arthritis?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.3. Specialist referral for psoriatic arthritis
- Q.
In people with psoriasis (all types) and suspected psoriatic arthritis, how quickly should referral to a specialist be made in order to minimise the impact of disease on symptoms, joint damage and quality of life?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.4. Incidence of comorbidities
- Q.
Are people with psoriasis at higher risk than people without psoriasis for significant comorbidities and are there subgroups within the psoriasis population at a further increased risk?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.5. Risk of skin cancer
- Q.
In people with psoriasis (all types) who have been exposed to coal tar, phototherapy (BBUVB, NBUVB and PUVA), systemic non-biological or biological therapy, what is the risk of skin cancer compared with people not exposed to these interventions and which individuals are at particular risk?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.6. Topical therapy
The following two questions were searched using a single strategy:
- Q.
In people with chronic plaque psoriasis of the trunk and/or limbs, what are the clinical effectiveness, safety, tolerability, and cost effectiveness of topical vitamin D or vitamin D analogues, potent or very potent corticosteroids, tar, dithranol and retinoids compared with placebo or vitamin D analogues, and of combined or concurrent vitamin D or vitamin D analogues and potent corticosteroids compared with potent corticosteroid or vitamin D or vitamin D analogues alone?
- Q.
In people with chronic plaque psoriasis at high impact or difficult-to-treat sites (scalp, flexures, face), what are the clinical effectiveness, safety, tolerability and cost effectiveness of vitamin D or vitamin D analogues, mild to very potent corticosteroids, combined or concurrent vitamin D or vitamin D analogue and potent corticosteroid, pimecrolimus, tacrolimus, tar, dithranol and retinoids compared with placebo, corticosteroids or vitamin D or vitamin D analogues?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.7. Phototherapy
- Q.
In people with psoriasis (all types), what are the clinical effectiveness, safety, tolerability and cost effectiveness of BBUVB, NBUVB and PUVA compared with each other or placebo/no treatment?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.8. Phototherapy combined with acitretin
- Q.
In people with psoriasis (all types), what are the clinical effectiveness, safety, tolerability and cost effectiveness of acitretin plus UVB (NBUVB and BBUVB) and acitretin plus PUVA compared with their monotherapies and compared with each other?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.9. Topicals combined with UVB
- Q.
In people with psoriasis (all types), what are the clinical effectiveness, safety, tolerability and cost effectiveness of UVB (NBUVB and BBUVB) combined with dithranol, coal tar or vitamin D or vitamin D analogues compared with UVB alone or topical therapy alone?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.10. Systemic non-biological therapy
- Q.
In people with psoriasis (all types), what are the clinical effectiveness, safety, tolerability and cost effectiveness of systemic methotrexate, ciclosporin and acitretin compared with each othr or with placebo?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.11. Methotrexate and risk of hepatotoxicity
- Q.
In people with psoriasis (all types) who are being treated with methotrexate, are there specific groups who are at high risk of hepatotoxicity?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.12. Methotrexate and monitoring of hepatotoxicity
- Q.
In people with psoriasis (all types) who are being treated with methotrexate or who are about to begin treatment with methotrexate, what is the optimum non-invasive method of monitoring hepatotoxicity (fibrosis or cirrhosis) compared with liver biopsy?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.13. Sequencing of biological therapy
- Q.
In people with chronic plaque psoriasis eligible to receive biological therapy, if the first biological agent fails, which is the next effective, safe and cost effective strategy?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.14. Cognitive behavioural therapy
- Q.
In people with psoriasis (all types), how effective are cognitive behavioural therapy (group and individual) interventions alone or as an adjunct to standard care compared with standard care alone for managing psychological aspects of the disease in reducing distress and improving quality of life?
Search constructed by combining the columns in the following table using the and Boolean operator
D.3.15. Self-management
- Q.
What strategies can best support people with psoriasis (all types) to self-manage the condition effectively?
Search constructed by combining the columns in the following table using the and Boolean operator
D.4. Economic searches
D.4.1. Economic evaluations
Economic searches were run in Medline and Embase by combining the standard population with the economic filter and limiting by date range (see table below). Economic searches were executed in the HEED and Centre for Reviews and Dissemination (CRD) (NHS EED and HTA) databases by simply running a standard population without a date limitation. Search terms for the HEED and CRD databases are given below.
Search constructed by combining the columns in the following table using the and Boolean operator
Table
2008- 08/03/2012 (Medline and Embase) All years -08/03/2012 (NHS EED, HTA and HEED)
D.4.2. Quality of life studies
Quality of life (QOL) searches were run in Medline and Embase by combining the standard population with the QOL filter (A.1.5) without a date limitation.
Search constructed by combining the columns in the following table using the AND Boolean operator
Publication Details
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Publisher
Royal College of Physicians (UK), London
NLM Citation
National Clinical Guideline Centre (UK). Psoriasis: Assessment and Management of Psoriasis. London: Royal College of Physicians (UK); 2012 Oct. (NICE Clinical Guidelines, No. 153.) Appendix D, Literature search strategies.