Quality assessmentNo of patientsEffectQuality
No of studiesDesignRisk of biasInconsistencyIndirectnessImprecisionOther considerationsVitamin D or vitamin D analoguesCorticosteroid (very potent)Relative (95% CI)Absolute
Investigator’s assessment (clear/nearly clear) - Calcipotriol (BD) vs clobetasol propionate (OD) (follow-up 4 weeks)
1
Reygagne 2005		randomised trialsseriousano serious inconsistencyseriousbseriouscnone21/75 (28%)38/76 (50%)RR 0.56 (0.37 to 0.86)220 fewer per 1000 (from 70 fewer to 315 fewer)⊕○○○
VERY LOW
Patient’s assessment (clear/nearly clear) - Calcipotriol (BD) vs clobetasol propionate (OD) (follow-up 4 weeks)
1
Reygagne 2005		randomised trialsseriousano serious inconsistencyseriousbseriouscnone23/75 (30.7%)36/76 (47.4%)RR 0.65 (0.43 to 0.98)166 fewer per 1000 (from 9 fewer to 270 fewer)⊕○○○
VERY LOW
Skin atrophy - Calcipotriol (BD) vs clobetasol propionate (OD) (follow-up 4 weeks)
1
Reygagne 2005		randomised trialsseriousdno serious inconsistencyseriousbvery seriouseNote that more cases of skin atrophy were present at baseline than week 4 and that in the clobetasol group it may only be 4 pts affected at different sites1/64 (1.6%)6/74 (8.1%)RR 0.19 (0.02 to 1.56)66 fewer per 1000 (from 79 fewer to 45 more)⊕○○○
VERY LOW
Withdrawals due to adverse events - Calcipotriol (BD) vs clobetasol propionate (OD) (follow-up 4 weeks)
1
Reygagne 2005		randomised trialsseriousano serious inconsistencyseriousbseriousfnone7/71 (9.9%)0/73 (0%)RR 15.42 (0.9 to 265)-⊕○○○
VERY LOW
a

Unclear allocation concealment; single blind (investigator); protocol violations included in ITT analysis; and relatively short duration of follow-up may produce an artificially high effect size in favour of the faster-acting clobetasol propionate

b

Different administration schedules for 2 groups: clobetasol once daily and washed out; calcipotriol twice daily and not washout out

c

Serious imprecision according to GDG discussion (confidence interval ranges from clinically important benefit/harm to no clinically important benefit/harm)

d

Unclear allocation concealment; single blind (investigator); protocol violations included in ITT analysis

e

Confidence interval crosses the boundary for clinical significance in favour of both treatments, as well as line of no effect

f

Confidence interval ranges from clinically important effect to no effect

From: 8, Topical therapy

Cover of Psoriasis
Psoriasis: Assessment and Management of Psoriasis.
NICE Clinical Guidelines, No. 153.
National Clinical Guideline Centre (UK).
Copyright © National Clinical Guideline Centre - October 2012.

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