news on eczema from the centre of evidence- based …isaac.auckland.ac.nz/resources/symposium...•...

News on eczema from the Centre of Evidence-Based Dermatology

Hywel Williams

University of Nottingham

© ISAAC Steering Committee 2011

Greetings from Nottingham


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Making connections....


≥15%10 to

ISAAC Phase Two


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The Koru of eczema


What I am going to cover

• Introduce the Centre of Evidence-Based Dermatology

• Our global collection of randomized controlled trials

• The water softener study• The Harmonising Outcome Measures for Eczema

project

• Our mapping of eczema systematic reviews • Five ways my practice has changed


Conflicts of interest• I work for the UK National Health Service

• I have no financial or research associations with pharmaceutical or for-profit companies

• I have previously accepted some emollient samples from a pharmaceutical exhibition

Williams HC, Naldi L, Paul C, et al Conflicts of interest in dermatology. Acta Derm Venereol. 2006;86(6):485-97.


The Centre of Evidence-Based Dermatology

www.nottingham.ac.uk/dermatology© ISAAC Steering Committee 2011

Recently published reviews:

• Probiotics for treating atopic dermatitis• Anti-staphylococcal interventions for atopic

dermatitis

• Topical treatments for chronic plaque psoriasis• Safety for topical corticosteroids in pregnancy• Excision margins for melanoma• Interventions for erythema nodosum leprosum• Interventions for Old World Cutan Leishmaniasis• Interventions for pemphigus vulgaris

15www.thecochranelibrary.com© ISAAC Steering Committee 2011

The UK Dermatology Clinical Trials Network


Trials portfolio- funded studies

Prophylactic Antibiotics for the Treatment of Cellulitis at Home: investigating whether prophylactic antibiotics can prevent further episodes of cellulitis of the leg (320K).

Study of Treatments for Pyoderma Gangrenosum Patients: first trial of its kind to formally evaluate the most commonly used treatments for pyoderma gangrenosum (800K) .

RCT to compare the safety and effectiveness of doxycycline with prednisolone for the treatment of bullous pemphigoid (830K).

Softened Water Eczema Trial: investigating whether water softeners help reduce the severity of eczema in children (930K).

LIMIT-1 Phase II study investigating the use of imiquimod in the treatment of lentigo maligna (250K)


NHS Evidence - skin disorders


National electronic library

www.library.nhs.uk/skin© ISAAC Steering Committee 2011





project

• Our mapping of eczema systematic reviews • Five ways my practice has changed as a result


Mapping the evidence on atopic eczema treatments:

....An update of all randomized controlled trials on atopic eczema since the 2000 HTA review

www.greatdatabase.org.uk© ISAAC Steering Committee 2011

http://www.greatdatabase.org.uk/�

Potential users

• Clinicians who want to see if their treatments have been tested properly

• Those writing treatment guidelines eg JDS

• Those doing systematic reviews

• Those writing funding applications


Please use it...........

www.greatdatabase.org.uk© ISAAC Steering Committee 2011

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project



Hard water and eczema

• Ecological link between hard water and eczema prevalence in UK, Spain and Japan

• Anecdote that eczema improves with soft water

• Link plausible since increased soap needed in hard water irritates the skin

www.swet-trial.co.uk© ISAAC Steering Committee 2011

Softened Water Eczema TrialA multi-centre randomised controlled trial of ion-exchange

water softeners for the treatment of eczema in children

Funded by the HTA (Health Technology Assessment programme)

Chief Investigator: Professor Hywel Williams

Centre of Evidence Based Dermatology, University of Nottingham


Study design

STUDY PERIOD = 16 weeks

0 to 12 weeks 12 to 16 weeks

Group A Usual eczema care + water softener installed (n = 155) Unit removed Option to purchase unit at reduced costGroup B Usual eczema care + delayed installation (n = 155) Unit installed

Parallel group, single-blind, randomised controlled trial


SWET Study now completed

• 330 children recruited = moderate/severe eczema

• Primary outcome = change in eczema severity at 12 weeks

• Huge interest and high follow-up• Results out PLoS Med Feb.15th!






project



The problem – how to measure eczema severity


Outcome measures – a real mess• Too many – at least 20 named scales

• Many not tested at all (Charman C et al JID 2003; 120:932–941)

• Some are only partly tested (validity, repeatability, sensitivity change, consistency, interpretability)

• Some that are tested do not pass the tests

Schmitt J, Langan S, Williams HC. What are the best outcome measurements for atopic eczema? A systematic review JACI 2007;120:1389-98.


SCORAD scores again

Take it EASI

Give me a POEM

SASSAD rules OK

ADASI tonight?

TIS a right mess

Me too!

My name is ADAM

IGADA bad headache

What’s all the FSSS about?

Meet my SIS


Why core outcomes?

• Easier to compare, contrast and synthesise results

• Reduces risk of inappropriate outcomes

• Reduces risk of selective reporting outcome bias


HOME IHarmonising Outcome Measures for

Eczema

Hywel Williams and Jochen SchmittUniversities of Nottingham and Dresden






project



The 2010 “map” of atopic eczema systematic reviews

Topical Treatments (56)

Systemic Treatments (45)

Prevention(32)

Epidemiology(21)

CAM (18)

Photo(14)

Dietary (13)

Psych (8)

Other (11)






project



Question: All this evidence is all very well, but has it made any difference to your clinical practice for people like me with eczema?


Five things that I have changed

1. I now only prescribe topical corticosteroids once a day

2. I do not prescribe bath emollients3. I use weekend therapy with TCS for maintaining

eczema remission4. I use topical tacrolimus and TCS concurrently at

different body sites and times of the week5. I am more likely to explore dietary factors in the

first year of life


What I have covered

• Introduced the Centre of Evidence-Based Dermatology

• Our global collection of randomized controlled trials – the GREAT database

• The water softener study - SWET• The Harmonising Outcome Measures for Eczema

project - HOME




News on eczema from the �Centre of Evidence-Based DermatologyGreetings from NottinghamSlide Number 3Making connections....Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9ISAAC Phase TwoThe Koru of eczemaWhat I am going to coverConflicts of interestThe Centre of Evidence-Based DermatologyRecently published reviews:The UK Dermatology Clinical Trials NetworkTrials portfolio- funded studiesNHS Evidence - skin disordersNational electronic librarySlide Number 20What I am going to coverMapping the evidence on atopic eczema treatments: �Potential usersSlide Number 24Slide Number 25Slide Number 26Slide Number 27Please use it...........What I am going to coverHard water and eczema�Softened Water Eczema Trial�A multi-centre randomised controlled trial of ion-exchange water softeners for the treatment of eczema in children�� Study designSWET Study now completedWhat I am going to coverThe problem – how to measure eczema severityOutcome measures – a real messSlide Number 37Why core outcomes?HOME I�Harmonising Outcome Measures for Eczema �What I am going to coverSlide Number 41Slide Number 42Slide Number 43Slide Number 44The 2010 “map” of atopic eczema systematic reviews What I am going to coverSlide Number 47Five things that I have changedWhat I have coveredSlide Number 50

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