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Cureus Aug 2023Oral spironolactone has been proposed as a potential treatment for hair loss due to its antiandrogenic properties. However, the efficacy and safety of spironolactone for... (Review)
Review
Oral spironolactone has been proposed as a potential treatment for hair loss due to its antiandrogenic properties. However, the efficacy and safety of spironolactone for treating hair loss are not well-established. The objective of this study was to conduct a systematic review of the current literature on the use of oral spironolactone in female pattern hair loss. We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies that assessed the efficacy and safety of oral spironolactone for treating hair loss. We searched for eligible papers in PubMed, Web of Science (ISI), Embase, and Scopus. All analyses were done using R software version 4.2.3 (R Foundation for Statistical Computing, Vienna, Austria). The overall rate of improved hair loss was 56.60%, with a higher rate of improvement (65.80%) observed in the combined therapy group compared to the monotherapy group (43.21%). However, there was significant heterogeneity in the efficacy outcomes, and hair loss did not improve or showed a modest improvement in 37.80% of all patients. The rates of adverse events reported in at least two studies were scalp pruritus or increased scurf (18.92%), menstrual disorders (11.85%), facial hypertrichosis (6.93%), and drug discontinuation (2.79%). The overall adverse events rate was 3.69%, but there was significant heterogeneity in the rates of different adverse events. In conclusion, the present study suggests that spironolactone is an effective and safe treatment option for hair loss. However, further research is needed to fully understand the heterogeneity of treatment response and adverse events and identify factors that may predict treatment response.
PubMed: 37719557
DOI: 10.7759/cureus.43559 -
Drug Delivery and Translational Research Jun 2023Needle-free jet injectors are used for the intralesional treatment of various dermatological indications. However, a systematic review that evaluates the efficacy and... (Review)
Review
Needle-free jet injectors are used for the intralesional treatment of various dermatological indications. However, a systematic review that evaluates the efficacy and safety of these treatments has not been published. The objectives of this study are to evaluate the efficacy and safety of needle-free jet injections for dermatological indications and to provide evidence-based treatment recommendations. An electronic literature search was conducted in April 2022. Two reviewers independently selected studies based on predefined criteria and performed a methodological quality assessment using the Cochrane Collaborations risk-of-bias 2.0 assessment tool and Newcastle-Ottawa Scale. Thirty-seven articles were included, involving 1911 participants. Dermatological indications included scars, alopecia areata, hyperhidrosis, nail diseases, non-melanoma skin cancer, common warts, local anesthesia, and aesthetic indications. Keloids and other types of scars (hypertrophic, atrophic, and burn scars) were investigated most frequently (n = 7). The included studies reported favorable efficacy and safety outcomes for intralesional jet injector-assisted treatment with triamcinolone acetonide/hexacetonide, 5-fluorouracil, bleomycin, or hyaluronic acid. Two high-quality studies showed good efficacy and tolerability of intralesional jet injections with a combination of 5-fluorouracil and triamcinolone acetonide in hypertrophic scars and with saline in boxcar and rolling acne scars. No serious adverse reactions and good tolerability were reported in the included studies. Overall, the methodological quality of the included studies was low. Limited evidence suggests that needle-free jet injector-assisted intralesional treatment is efficacious and safe for hypertrophic and atrophic acne scars. More well-powered RCTs investigating the efficacy and safety of jet injector treatment in dermatology are warranted to make further evidence-based recommendations.
Topics: Humans; Triamcinolone Acetonide; Dermatology; Keloid; Fluorouracil; Acne Vulgaris; Treatment Outcome
PubMed: 36884194
DOI: 10.1007/s13346-023-01295-x -
Oncology Nursing Forum Sep 2020Preventing and managing skin toxicities can minimize treatment disruptions and improve well-being. This systematic review aimed to evaluate the effectiveness of... (Meta-Analysis)
Meta-Analysis
PROBLEM IDENTIFICATION
Preventing and managing skin toxicities can minimize treatment disruptions and improve well-being. This systematic review aimed to evaluate the effectiveness of interventions for the prevention and management of cancer treatment-related skin toxicities.
LITERATURE SEARCH
The authors systematically searched for comparative studies published before April 1, 2019. Study selection and appraisal were conducted by pairs of independent reviewers.
DATA EVALUATION
The random-effects model was used to conduct meta-analysis when appropriate.
SYNTHESIS
39 studies (6,006 patients) were included; 16 of those provided data for meta-analysis. Prophylactic minocycline reduced the development of all-grade and grade 1 acneform rash in patients who received erlotinib. Prophylaxis with pyridoxine 400 mg in capecitabine-treated patients lowered the risk of grade 2 or 3 hand-foot syndrome. Several treatments for hand-foot skin reaction suggested benefit in heterogeneous studies. Scalp cooling significantly reduced the risk for severe hair loss or total alopecia associated with chemotherapy.
IMPLICATIONS FOR RESEARCH
Certainty in the available evidence was limited for several interventions, suggesting the need for future research.
SUPPLEMENTAL MATERIAL CAN BE FOUND AT HTTPS
//onf.ons.org/supplementary-material-targeted-therapy-and-chemotherapy-associated-skin-toxicity-systematic-review.
Topics: Erlotinib Hydrochloride; Humans; Skin Diseases
PubMed: 32830797
DOI: 10.1188/20.ONF.E149-E160 -
American Journal of Clinical Dermatology May 2023Basal cell carcinoma (BCC) of the skin is the most common form of skin cancer in the United States. In life-threatening, advanced BCC, sonic hedgehog inhibitors (SSHis)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Basal cell carcinoma (BCC) of the skin is the most common form of skin cancer in the United States. In life-threatening, advanced BCC, sonic hedgehog inhibitors (SSHis) remain a pre-eminent treatment option for locally advanced BCC and metastatic BCC.
OBJECTIVE
In this updated systematic review and meta-analysis, we aimed to better characterize the efficacy and safety of SSHis by including final updates from pivotal clinical trials and additional new recent studies.
METHODS
An electronic database search was performed for articles including clinical trials, prospective case series, and retrospective medical record reviews on human subjects. Overall response rates (ORRs) and complete response rates (CRRs) were the primary outcomes. For safety assessment, the prevalence of the following adverse effects was analyzed: muscle spasms, dysgeusia, alopecia, weight loss, fatigue, nausea, myalgias, vomiting, skin squamous cell carcinoma, increased creatine kinase, diarrhea, decreased appetite, and amenorrhea. Analyses were performed using R statistical software. Data were pooled using linear models with fixed effects meta-analysis for primary analyses, along with 95% confidence intervals (CIs) and p-values. Intermolecular differences were calculated using Fisher's exact test.
RESULTS
A total of 22 studies (N = 2384 patients) were included in the meta-analysis: 19 studies assessing both efficacy and safety, 2 studies assessing safety only, and 1 study assessing efficacy only. Overall, the pooled ORR for all patients was 64.9% (95% CI 48.2-81.6%), implicating there is at least a partial response (z = 7.60, p < 0.0001) in most patients receiving SSHis. The ORR for vismodegib was 68.5% and 50.1% for sonidegib. The most common adverse effects for vismodegib and sonidegib were muscle spasms (70.5% and 61.0%, respectively), dysgeusia (58.4% and 48.6%, respectively), and alopecia (59.9% and 51.1%, respectively). Patients were likely to experience weight loss (35.1%, p < 0.0001) from vismodegib. Alternatively, patients taking sonidegib experienced more nausea, diarrhea, increased creatine kinase levels, and decreased appetite compared with those receiving vismodegib.
CONCLUSION
SSHis are an effective treatment for advanced BCC disease. Given the high discontinuation rates, management of patient expectations is warranted for compliance and achieving long-term efficacy. It is essential to stay updated with the latest discoveries on the efficacy and safety of SSHis.
Topics: Female; Humans; Hedgehog Proteins; Dysgeusia; Retrospective Studies; Antineoplastic Agents; Carcinoma, Basal Cell; Skin Neoplasms; Anilides; Spasm; Diarrhea; Drug-Related Side Effects and Adverse Reactions; Alopecia; Nausea; Weight Loss; Creatine Kinase
PubMed: 36795228
DOI: 10.1007/s40257-023-00763-x -
Skinmed 2015Topical minoxidil has become a mainstay in the treatment of androgenetic alopecia (AGA). Despite being a longstanding treatment for AGA, relatively few reviews of its... (Meta-Analysis)
Meta-Analysis Review
Topical minoxidil has become a mainstay in the treatment of androgenetic alopecia (AGA). Despite being a longstanding treatment for AGA, relatively few reviews of its efficacy have been published. The current study sought to synthesize the available efficacy data by performing a systematic review of the literature and conducting random-effects pairwise meta-analyses for the outcomes percent increase in hair count from baseline, investigator assessment, and patient self-assessment. Results showed that minoxidil is more effective than placebo in promoting total and nonvellus hair growth (mean difference [MD], 16.68; 95% confidence interval [CI], 9.34-24.03 and MD, 20.90; 95% CI, 9.07-32.74). A significantly higher proportion of participants in the minoxidil group had greater hair growth than participants in the placebo group as judged by both investigators and self-reports (relative risk [RR], 2.28; 95% CI, 1.58-3.31 and RR, 1.56; 95% CI, 1.34-1.80). Despite significant clinical efficacy, cosmetically acceptable results are present in only a subset of patients. Compliance is thought to be a major limiting factor and is being addressed by novel formulations and combinations.
Topics: Administration, Topical; Alopecia; Humans; Male; Minoxidil; Vasodilator Agents
PubMed: 26380504
DOI: No ID Found -
Advances in Clinical and Experimental... Jul 2023Female pattern hair loss (FPHL) is a hereditary form of hair loss in women and the most common patterned progressive hair loss in female patients with androgenetic... (Review)
Review
A systematic review of clinical trials using single or combination therapy of oral or topical finasteride for women in reproductive age and postmenopausal women with hormonal and nonhormonal androgenetic alopecia.
Female pattern hair loss (FPHL) is a hereditary form of hair loss in women and the most common patterned progressive hair loss in female patients with androgenetic alopecia (AGA). One of the best methods for treating hair loss in women is the finasteride treatment. This systematic review includes a summary of the pharmacology of finasteride and the effect of the drug on women, especially those in the menopausal age group, and is aimed at elucidating methods of preventing systematic side effects. A search of all published literature from 1999 to 2020 has been conducted with the use of PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane, as well as Cochrane Skin databases. A total of 380 articles were found, of which 260 articles were removed and 87 review studies were excluded. Lastly, full texts of 33 original articles were reviewed and 14 articles that met the inclusion criteria were selected. Ten out of the 14 articles reported a high rate of alopecia recovery in women taking finasteride. Based on the results, it can be stated that 5 mg of oral finasteride per day could be an effective and safe treatment in normoandrogenic women with FPHL, especially when used in combination with other drugs, such as topical estradiol and minoxidil. We also found that topical finasteride is more effective than other topical formulas for treating hair loss.
Topics: Humans; Female; Finasteride; Postmenopause; Alopecia; Minoxidil; Combined Modality Therapy; Treatment Outcome
PubMed: 36897103
DOI: 10.17219/acem/157990 -
Rheumatology International Jul 2017The aim is to systematically review the treatment for lupus nephritis (LN) by performing an overview of systematic reviews and meta-analyses. Electronic databases of... (Review)
Review
The aim is to systematically review the treatment for lupus nephritis (LN) by performing an overview of systematic reviews and meta-analyses. Electronic databases of OVID MEDLINE, OVID EMBASE, and Cochrane Library were searched to identify published systematic reviews and meta-analyses investigating treatments for LN up to 13 July 2016. A measurement tool to assess systematic reviews (AMSTAR) was used to assess the quality of included studies. Totally, 24 studies were included. Of the eligible studies, 3 studies were rated as poor quality, 11 as moderate, and 10 as good. In LN induction therapy, comparing to cyclophosphamide, tacrolimus had higher complete remission rate, response rate, and anti-dsDNA negative conversion rate and led to lower risks of gastrointestinal symptoms and amenorrhea, and mycophenolate mofetil (MMF) was associated with higher response rate and less adverse events of leucopenia, alopecia, and ovarian failure. However, there was no difference in the efficacy and adverse events between tacrolimus and MMF. In LN maintenance therapy, the relapse rate and leucopenia rate were lower in MMF group than in azathioprine group, but there were no differences of end-stage kidney disease rate and mortality rate between the two groups. For LN induction therapy, both Tacrolimus and MMF are more effective and safer than cyclophosphamide, while there are no differences of efficacy or safety between the two treatments. For LN maintenance therapy, MMF seems to have less adverse events and lower relapse rate than azathioprine.
Topics: Disease Progression; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Lupus Nephritis; Meta-Analysis as Topic; Odds Ratio; Recurrence; Remission Induction; Risk Factors; Treatment Outcome
PubMed: 28493175
DOI: 10.1007/s00296-017-3733-2 -
Cutaneous and Ocular Toxicology Jun 2022Alopecia Areata is a nonscarring hair loss disorder and is the most common hair loss cause in children. It is a chronic autoimmune disorder with a severe psychological...
INTRODUCTION
Alopecia Areata is a nonscarring hair loss disorder and is the most common hair loss cause in children. It is a chronic autoimmune disorder with a severe psychological impact in patients' lives. JAK inhibitors, in particular Tofacitinib, have been having promising results on Alopecia Areata Treatment. In this study we aimed to do a Systematic Review on the role of Tofacitinib (either orally or topically), considering efficacy and safety, in treating children with Alopecia Areata.
MATERIALS AND METHODS
PubMed, Cochrane and Web of Science databases were searched (up to 1st of September of 2021) looking for Tofacitinib (all text/all fields) and MeSH/Keyword term Alopecia Areata.
RESULTS AND CONCLUSIONS
We included 14 studies and 64 cases in the Systematic Review. From these, 12 were considering systemic administration (47 patients) and two were considering topical administration (17 patients). Responsiveness was as high as 81.3%. The responsiveness was similar among different genders (78.6% in males and 80.0% in females) and either whether administration was topic (70.6% responsiveness) or systemic (85.1% responsiveness). Adverse effects were rare and, when present, were mild. Studies shows promising results in what considers the efficacy and safety of Tofacitinib in the treatment of Alopecia Areata. As the available evidence to date is of low quality, further randomised studies are required to confirm these findings.
Topics: Alopecia; Alopecia Areata; Child; Female; Humans; Male; Piperidines; Pyrimidines
PubMed: 35687530
DOI: 10.1080/15569527.2022.2084622 -
The Journal of Dermatological Treatment Dec 2023To conduct a systematic review and meta-analysis to verify the efficacy of using autologous platelet-rich plasma (PRP) in female pattern alopecia (FPA). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To conduct a systematic review and meta-analysis to verify the efficacy of using autologous platelet-rich plasma (PRP) in female pattern alopecia (FPA).
BACKGROUND
Androgenetic alopecia is the leading cause of hair loss in men andwomen and often impacts self-esteem and quality of life.
DATA SOURCES
MEDLINE/PubMed, Cochrane Library, ClinicalTrials.gov, and EMBASE up to May 2021.
STUDY SELECTION AND DATA EXTRACTION
We identified all studies evaluating the effect of PRP in FPA. A narrative synthesis was performed from data on the efficacy of PRP treatment and adverse effects; quantitative results of PRP use compared to control treatment for female androgenetic alopecia (AGA) were synthesized. The outcomes analyzed were terminal density and hair thickness.
RESULTS
Seven articles were selected for this review. Meta-analysis showed that PRP-based interventions were able to increase terminal hair density compared to control (standardized mean difference (SMD)=2.98, 95% confidence intervals (CIs)=1.10, 4.85), with no significant increase in hair thickness (SMD = 1.16, 95% CI= -0.96, 3.28). During and after treatment, no major side effects were reported by patients or researchers.
CONCLUSIONS
The use of autologous PRP injections in female AGA seems to be promising, with more consistent results on terminal hair density. However, caution is recommended in the interpretation of these results until they can be replicated in larger and more representative samples. PROSPERO registration number CRD42021257154.
Topics: Male; Humans; Female; Quality of Life; Treatment Outcome; Alopecia; Hair; Platelet-Rich Plasma
PubMed: 36264022
DOI: 10.1080/09546634.2022.2138692 -
Frontiers in Immunology 2023It is now widely accepted that radiotherapy (RT) can provoke a systemic immune response, which gives a strong rationale for the combination of RT and immune checkpoint... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is now widely accepted that radiotherapy (RT) can provoke a systemic immune response, which gives a strong rationale for the combination of RT and immune checkpoint inhibitors (ICIs). However, RT is a double-edged sword that not only enhances systemic antitumor immune response, but also promotes immunosuppression to some extent. Nevertheless, many aspects regarding the efficacy and safety of this combination therapy remain unknown. Therefore, a systematic review and meta-analysis was performed in order to assess the safety and efficacy of RT/chemoradiotherapy (CRT) and ICI combination therapy for non-small cell lung cancer (NSCLC) patients.
METHODS
PubMed and several other databases were searched (according to specific criteria) to find relevant studies published prior to the 28 of February 2022.
RESULTS
3,652 articles were identified for screening and 25 trials containing 1,645 NSCLC patients were identified. For stage II-III NSCLC, the one- and two-year overall survival (OS) was 83.25% (95% confidence interval (CI): 79.42%-86.75%) and 66.16% (95% CI: 62.3%-69.92%), respectively. For stage IV NSCLC, the one- and two-year OS was 50% and 25%. In our study, the pooled rate of grade 3-5 adverse events (AEs) and grade 5 AEs was 30.18% (95% CI: 10.04%-50.33%, I: 96.7%) and 2.03% (95% CI: 0.03%-4.04%, I: 36.8%), respectively. Fatigue (50.97%), dyspnea (46.06%), dysphagia (10%-82.5%), leucopenia (47.6%), anaemia (5%-47.6%), cough (40.09%), esophagitis (38.51%), fever (32.5%-38.1%), neutropenia (12.5%-38.1%), alopecia (35%), nausea (30.51%) and pneumonitis (28.53%) were the most common adverse events for the combined treatment. The incidence of cardiotoxicity (0%-5.00%) was low, but it was associated with a high mortality rate (0%-2.56%). Furthermore, the incidence of pneumonitis was 28.53% (95% CI: 19.22%-38.88%, I: 92.00%), grade ≥ 3 pneumonitis was 5.82% (95% CI: 3.75%-8.32%, I: 57.90%) and grade 5 was 0%-4.76%.
CONCLUSION
This study suggests that the addition of ICIs to RT/CRT for NSCLC patients may be both safe and feasible. We also summarize details of different RT combinations with ICIs to treat NSCLC. These findings may help guide the design of future trials, the testing of concurrent or sequential combinations for ICIs and RT/CRT could be particularly useful to guide the treatment of NSCLC patients.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Immune Checkpoint Inhibitors; Chemoradiotherapy; Combined Modality Therapy
PubMed: 36993952
DOI: 10.3389/fimmu.2023.1065510