Quality assessmentNo of patientsEffectQuality
No of studiesDesignRisk of biasInconsistencyIndirectnessImprecisionOther considerationsPotent corticosteroid
Time-to- clearance or near clearance (follow-up 4–8 weeks)
1
Fleming2010A
observational studiesano serious risk of biasbno serious inconsistencyno serious indirectnessno serious imprecisionnoneBetamethasone dipropionate OD
83
Clear/nearly clear (investigator’s static assessment)⊕⊕○○
LOW
Week 48 (9.6%)
Week 814 (16.9%)
Time-to-marked improvement or clearance (follow-up 8–22 days)
1
Medansky 1987
observational studiesano serious risk of biasbno serious inconsistencyno serious indirectnessno serious imprecisionnoneMometasone furoate OD
58
Patients achieving marked improvement or clearance⊕⊕○○
LOW
8 days4/58 (6.9%)
15 days12/55 (21.8%)
22 days18/50 (36.0%)
Time-to-excellent or good improvement (follow-up 7–21 days)
1
Sears 1997
observational studiesano serious risk of biascno serious inconsistencyserious indirectnessdno serious imprecisionnoneHydrocortisone buteprate BD
84
Patients achieving excellent or good improvement⊕○○○
VERY LOW
Day 7:15/84 (17.9%)
Day 14:24/84 (28.2%)
Day 21:32/78 (41.3%)
Mean time to remission (IAGI – clear, excellent or good) (follow-up 4 weeks)
1
Olsen 1996 – study A
observational studiesano serious risk of biasbno serious inconsistencyseriousdno serious imprecisionseriouseFluticasone propionate BD
88
Investigator’s assessment⊕○○○
VERY LOW
Week 1
Clear0
Excellent/good55%
Week 2
Clear4%
Excellent/good60%
Week 3
Clear4%
Excellent/good65%
Week 4
Clear11%
Excellent/good60%
Mean time to remission (IAGI – clear, excellent or good) (follow-up 4 weeks)
1
Olsen 1996 – study B
observational studiesano serious risk of biasbno serious inconsistencyseriousdno serious imprecisionseriouseFluticasone propionate BD
105
Investigator’s assessment⊕○○○
VERY LOW
Week 1
Clear0
Excellent/good29%
Week 2
Clear0
Excellent/good50%
Week 3
Clear0
Excellent/good65%
Week 4
Clear3%
Excellent/good66%
Time-to-maximum response (% change in PASI; follow-up 2–6 weeks)
1
Thawornchaisit 2007
observational studiesano serious risk of biascno serious inconsistencyno serious indirectnessno serious imprecisionnoneBetamethasone valerate BD
30
Mean PASI and % change in PASI score from baseline⊕⊕○○
LOW
2 weeks12.95±3.4
−27.23±10.6%
4 weeks8.68±3.8
−51.41±18.2%
6 weeks5.52±4.5
−69.36±23.3%
Time-to-maximum response (change in PASI; follow-up 2–6 weeks)
1
Cunliffe 1992
observational studiesano serious risk of biascno serious inconsistencyno serious indirectnessno serious imprecisionnoneBetamethasone valerate BD

200
Mean (SD) change in PASI from baseline⊕⊕○○
LOW
Mean at baseline9.35
2 weeks3.39 (2.16)
4 weeks4.50 (5.33)
6 weeks5.32 (6.06)
a

Although the data are taken from randomised trials the benefit of control data is not being utilised as considerations are being made based on single interventions without reference to the comparator arm

b

Unclear allocation concealment may have biased patient selection for this intervention and there was a high rate of dropout (21.5%)

c

Unclear allocation concealment may have biased patient selection for this intervention

d

Incorrect definition of response

e

Note that only percentages of responders are available and it is unclear whether the number of participants were assessed at each time point

From: 8, Topical therapy

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Psoriasis: Assessment and Management of Psoriasis.
NICE Clinical Guidelines, No. 153.
National Clinical Guideline Centre (UK).
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