The Journal of investigative dermatology
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When making treatment decisions, it is often necessary to consider the relative efficacy and safety of multiple potential interventions. Unlike traditional pairwise meta-analysis, which allows for a comparison between two interventions by pooling head-to-head data, network meta-analysis (NMA) allows for the simultaneous comparison of more than two interventions and for comparisons to be made between interventions that have not been directly compared in a randomized controlled trial. ⋯ There are also multiple NMA outputs that researchers and knowledge users should familiarize themselves with in order to understand NMA results (e.g., network plots, mean ranks). Our goals in this article are to: (i) demonstrate how NMAs differ from pairwise meta-analyses, (ii) describe types of evidence in a NMA, (iii) explain NMA model assumptions, (iv) provide readers with an approach to interpreting a NMA, (v) discuss areas of ongoing methodological research, and (vi) provide a brief overview of how to conduct a systematic review and NMA.
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J. Invest. Dermatol. · Apr 2018
Multicenter Study Observational StudyDifferential Drug Survival of Second-Line Biologic Therapies in Patients with Psoriasis: Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR).
Little is known about the drug survival of second-line biologic therapies for psoriasis in routine clinical practice. We assessed drug survival of second-line biologic therapies and estimated the risk of recurrent discontinuation due to adverse events or ineffectiveness in patients with psoriasis who had failed a first biologic therapy and switched to a second in a large, multicenter pharmacovigilance registry (n = 1,239; adalimumab, n = 538; etanercept, n = 104; ustekinumab, n = 597). The overall drug survival rate in the first year after switching was 77% (95% confidence interval = 74-79%), falling to 58% (55-61%) in the third year. ⋯ Discontinuation of the first biologic therapy because of adverse events was associated with an increased rate of second drug discontinuation because of adverse events (hazard ratio = 2.55; 95% confidence interval = 1.50-4.32). In conclusion, drug survival rates differed among biologic therapies and decreased over time; second-line discontinuation because of adverse events was more common among those who discontinued first-line treatment for this reason. The results of this study should support clinical decision making when choosing second-line biologic therapy for patients with psoriasis.
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Patients who suffer from lymphedema have impaired immunity and, as a result, are at an increased risk for infections. Furthermore, previous studies have shown that lymphadenectomy impairs acquisition of adaptive immune responses and antibody production in response to foreign antigens. Although it is clear that antigen presentation in lymph nodes plays a key role in adaptive immunity, the cellular mechanisms that regulate impaired immune responses in patients with lymphedema or following lymphatic injury remain unknown. ⋯ In this study, we focus on the role of regulatory T cells in immunosuppression and show that regulatory T-cell proliferation in tissues distal to site of lymphatic injury contributes to impaired innate and adaptive immune responses. More importantly, using Foxp3-DTR transgenic mice, we show that depletion of regulatory T cells in the setting of lymphatic injury restores these critical immune-mediated responses. These findings provide additional evidence that immune responses following lymphatic injury play a key role in mediating the pathology of lymphedema.
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J. Invest. Dermatol. · Sep 2017
Incidence, Mortality, and Trends of Nonmelanoma Skin Cancer in Germany.
Increasing incidence rates (IRs) of nonmelanoma skin cancer (NMSC) in white populations have been described worldwide. Cancer registry data from the Saarland and Schleswig-Holstein federal states were used to analyze incidence and mortality trends in Germany. Age-standardized rates were compared with crude rates to assess disease burden. ⋯ The predicted crude IRs for the same year are males, 450-500 cases; females, 380-430 cases. There is a continuous long-term increase of NMSC incidence with no tendency for leveling off. By 2030, the current NMSC IR in Germany is expected to double.