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The Cochrane Database of Systematic... Oct 2015Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterised by recurrent painful boils in flexural sites, such as the axillae and groin, that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterised by recurrent painful boils in flexural sites, such as the axillae and groin, that affects about 1% of the population, with onset in early adulthood.
OBJECTIVES
To assess the effects of interventions for HS in people of all ages.
SEARCH METHODS
We searched the following databases up to 13 August 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (Issue 7, 2015), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers and handsearched the conference proceedings of eight dermatology meetings. We checked the reference lists of included and excluded studies for further references to relevant trials.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of all interventions for hidradenitis suppurativa.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed study eligibility and methodological quality and performed data extraction. Our primary outcomes were quality of life, measured by a validated dermatology-specific scale, and adverse effects of the interventions.
MAIN RESULTS
Twelve trials, with 615 participants, met our inclusion criteria. The median number of participants in each trial was 27, and median trial duration was 16 weeks. The included studies were conducted over a 32-year time period, from 1983 to 2015. A single RCT that was underpowered to detect clinically meaningful differences investigated most interventions.There were four trials of anti-TNF-α (tumour necrosis factor-alpha) therapies, which included etanercept, infliximab, and adalimumab. Adalimumab 40 mg weekly improved the Dermatology Life Quality Index (DLQI) score in participants with moderate to severe HS by 4.0 points relative to placebo (95% confidence interval (CI) -6.5 to -1.5 points), an effect size approximately equal to the DLQI minimal clinically important difference. We reduced the evidence quality to 'moderate' because the effect size was based on the results of only one study. In a meta-analysis of two studies with 124 participants, standard dose adalimumab 40 mg every other week was ineffective compared with placebo (moderate quality evidence). In a smaller study of 38 participants, of whom only 33 provided efficacy data, infliximab 5 mg/kg treatment improved DLQI by 8.4 DLQI points after eight weeks. Etanercept 50 mg twice weekly was well tolerated but ineffective.In a RCT of 200 participants, no difference was found in surgical complications (week one: risk ratio (RR) 0.78, 95% CI 0.58 to 1.05, moderate quality evidence) or risk of recurrence (after three months: RR 0.96, 95% CI 0.68 to 1.34, moderate quality evidence) in those randomised to receive a gentamicin-collagen sponge prior to primary closure compared with primary closure alone.RCTs of other interventions, including topical clindamycin 1% solution; oral tetracycline; oral ethinylestradiol 50 mcg with either cyproterone acetate 50 mg or norgestrel 500 mcg; intense pulsed light; neodymium-doped yttrium aluminium garnet (Nd:YAG) laser; methylene blue gel photodynamic therapy; and staphage lysate, were relatively small studies, preventing firm conclusions due to imprecision.
AUTHORS' CONCLUSIONS
Many knowledge gaps exist in RCT evidence for HS. Moderate quality evidence exists for adalimumab, which improves DLQI score when 40 mg is given weekly, twice the standard psoriasis dose. However, the 95% confidence interval includes an effect size of only 1.5 DLQI points, which may not be clinically relevant, and the safety profile of weekly dosing has not been fully established. Infliximab also improves quality of life, based on moderate quality evidence.More RCTs are needed in most areas of HS care, particularly oral treatments and the type and timing of surgical procedures. Outcomes should be validated, ideally, including a minimal clinically important difference for HS.
Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Female; Hidradenitis Suppurativa; Humans; Intense Pulsed Light Therapy; Laser Therapy; Male; Photochemotherapy; Phototherapy; Randomized Controlled Trials as Topic; Tumor Necrosis Factor-alpha
PubMed: 26443004
DOI: 10.1002/14651858.CD010081.pub2 -
Journal of Clinical Microbiology Jan 1982We examined the blastogenic responses of lymphocytes to Staphylococcus aureus antigen in 49 uninfected non-insulin-dependent diabetic subjects and in 56 uninfected...
We examined the blastogenic responses of lymphocytes to Staphylococcus aureus antigen in 49 uninfected non-insulin-dependent diabetic subjects and in 56 uninfected nondiabetic subjects. We found a significantly decreased response to this antigen in the diabetic patients (P less than 0.05). Diabetics whose blood sugar levels were less than 150 mg/dl showed significantly decreased responses, as did diabetics whose blood sugar levels were greater than 200 mg/dl. The use of fetal calf serum in place of autologous plasma did not correct the defect. In a smaller number of patients, we observed a decreased response to tetanus toxoid, which was significant (P less than 0.05). The response to phytohemagglutinin was not significantly different from normal controls (P greater than 0.4). These results indicated that non-insulin-dependent diabetics, as well as insulin-dependent diabetics (previously reported), show decreased responses to S. aureus antigen and to tetanus toxoid. This defect apparently is not related to blood glucose levels or other serum factors.
Topics: Adult; Age Factors; Aged; Antigens, Bacterial; Diabetes Mellitus, Type 2; Humans; Lymphocyte Activation; Lymphocytes; Middle Aged; Phytohemagglutinins; Staphylococcus aureus; Tetanus Toxoid
PubMed: 7186900
DOI: 10.1128/jcm.15.1.109-114.1982 -
Infection and Immunity Jan 1973Mice which had been subjected to mycobacterial infection and specific elicitation were bled from the orbital sinus at the time the mice were challenged intravenously...
Mice which had been subjected to mycobacterial infection and specific elicitation were bled from the orbital sinus at the time the mice were challenged intravenously with vaccinia virus. Assays of the sera were negative for interferon. Sera of rabbits sensitized with staphylococci and elicited by Staphage Lysate also lacked detectable circulating interferon.
PubMed: 16558071
DOI: 10.1128/iai.7.1.117-118.1973