Treatments for Pyoderma Gangrenosum: A Systematic Review and Single‐Arm Meta‐Analysis of Systemic Therapies.
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis associated with significant morbidity and mortality, with no consensus treatment to date. To review all clinical trials of treatments for PG to synthesise clinical evidence regarding the efficacy and safety of different treatments. After PROSPER...
| Publicado en: | International Wound Journal Vol. 22; no. 8; pp. 1 - 16 |
|---|---|
| Autores principales: | , , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2025
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=187569169&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 187569169 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17424801 1725 jtl: International Wound Journal issn: 17424801 maglogo: Y pubinfo: dt: Aug2025 vid: 22 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 187569169 187569169 187569169 10.1111/iwj.70733 187569169 ppf: 1 ppct: 15 formats: tig: atl: Treatments for Pyoderma Gangrenosum: A Systematic Review and Single‐Arm Meta‐Analysis of Systemic Therapies. aug: au: Kaur, Manjit Diaz, Michael J. Anthony, Michelle Jolley, Dana Schildmeyer, Anna H. McFeeters, Jacob Kaffenberger, Benjamin H. affil: Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus Ohio,, USA sug: subj: Pyoderma Gangrenosum Therapy Pyoderma Gangrenosum Risk Factors Pyoderma Gangrenosum Mortality Morbidity Patient Safety Treatment Outcomes Human Systematic Review Meta Analysis Embase PubMed Quality Assessment Immunologic Factors Treatment Failure Adalimumab Infliximab Chlorambucil Cyclosporine Cyclophosphamide Prednisolone Descriptive Statistics Confidence Intervals Recurrence ab: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis associated with significant morbidity and mortality, with no consensus treatment to date. To review all clinical trials of treatments for PG to synthesise clinical evidence regarding the efficacy and safety of different treatments. After PROSPERO (CRD42023459180) registration, we systematically searched five databases (clinicaltrials.gov, CENTRAL, Embase, PubMed and Scopus) up until 18th May 2024 for PG treatments. Of 10 579 identified articles, 5853 deduplicated abstracts were screened. Twenty studies met the screening criteria after a full text review of 60 articles. We assessed the risk of bias using ROBIN‐I for non‐randomised and ROB‐2 for randomised trials. Two reviewers independently performed article screening and quality assessments. Two reviewers independently extracted and recorded data on study characteristics, participants' demographics, disease characteristics, treatment regimens, and outcomes for the selected studies. A single‐arm meta‐analysis of available RCTs and non‐randomised studies was conducted to analyse the outcomes of different systemic immunomodulators. The primary outcome was the complete healing of PG. Secondary outcomes included rates of recurrence, treatment failure, adverse events and time to complete healing. A total of twenty (20) interventional studies were included in the data synthesis: nine (9) prospective open‐label studies, six (6) prospective cohort studies, three (3) open‐label clinical trials, and two (2) randomised controlled trials evaluating multiple biological, systemic, and topical interventions. On random effects meta‐analysis of systemic therapies including adalimumab, canakinumab, infliximab, chlorambucil, cyclosporine, cyclophosphamide and prednisolone, the pooled proportion of complete healing across 11 studies was 0.59 (95% confidence interval [CI]: 0.41–0.74; Χ2 = 26.66, p < 0.01; I2 = 66%); the pooled proportion of PG recurrence across 6 studies was 0.30 (95% CI: 0.20–0.41; Χ2 = 1.14, p = 0.95; I2 = 0%); the pooled proportion of serious adverse effects from 4 studies was 0.10 (95% CI: 0.05–0.19; Χ2 = 5.01, p = 0.17; I2 = 40%); and the pooled proportion of PG treatment failure across seven studies was 0.36 (95% CI: 0.24–0.49; Χ2 = 12.78, p = 0.03; I2 = 61%). The proportion of complete wound healing varies significantly across treatments and recurrence is common even in a limited follow‐up period. Heterogeneity of study methods and low numbers hamper disease research. There remains a significant unmet need for better outcome measures than just complete healing as well as better treatment options to improve patient outcomes. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|