What is meant by a "flare" in atopic dermatitis? A systematic review and proposal
What is meant by a "flare" in atopic dermatitis? A systematic review and proposal
复制标题
DOI：
10.1001/archderm.142.9.1190
复制
发表时间：
2006-09-01
影响因子：
--
通讯作者：
Williams, Hywel C.
中科院分区：
文献类型：
--
作者：
Langan, Sinead M.;Thomas, Kim S.;Williams, Hywel C.
目的：基于对文献的系统回顾和临床试验的经验，为临床研究中特应性皮炎（AD）发作的定义提出初步建议。 数据来源：于2005年4月19日对MEDLINE传记数据库进行敏感电子检索，使用以下检索词：flare$、exacerbation$、relaps$、remission$、worse$和*recurrence。检索仅限于人类 AD 的所有前瞻性研究，使用 AD 和前瞻性研究的 Cochrane 检索词。此外，我们还检索了有关 3 种慢性间歇性疾病（哮喘、类风湿关节炎和多发性硬化症）的文献，以深入了解其他学科如何处理耀斑的定义。数据综合：共回顾了 401 条引用，其中 16 篇文章（15 项研究）相关。全部都是临床试验。检索到的文章中疾病发作或复发的定义可分为 3 个广泛的主题：（1）包含至少 2 个不同因素（例如症状、严重程度持续时间或治疗）的复合定义（4 项研究）； (2) 评分阈值或严重程度评分的变化（8项研究）； (3) 行为定义，例如救援疗法的使用（3 项研究）。只有 1 个研究小组（3 项研究）使用了相同的定义。纳入的研究均不是主要旨在制定“耀斑”的定义。来自其他学科的证据表明，至少有 2 种措施（哮喘研究中的完全控制周和良好控制周）可以成功用于 AD 研究。结论：定义 AD 发作是一个复杂的过程，本次综述强调了在定义长期疾病控制措施时需要标准化。我们建议将 AD 发作简单地定义为需要升级治疗或寻求额外医疗建议的发作。还应考虑完全控制周和良好控制周来评估 AD 患者的总体疾病活动性。总之，这些定义直观、易于使用且易于理解。未来的工作需要测试这些建议在各种研究环境中的适用性。
Objective: To make preliminary recommendations for defining a flare of atopic dermatitis ( AD) in clinical research based on a systematic review of the literature and experience in running clinical trials.Data Sources: A sensitive electronic search of MEDLINE biographic database was conducted on April 19, 2005, using the following search terms: flare$, exacerbation$, relaps$, remission$, worse$, and * recurrence. The search was restricted to all prospective studies of AD in humans, using the Cochrane search terms for AD and prospective studies. In addition, we searched the literature on 3 chronic intermittent diseases ( asthma, rheumatoid arthritis, and multiple sclerosis) to gain insight as to how other disciplines had tackled the definition of flares.Data Synthesis: A total of 401 citations were reviewed, of which 16 articles ( 15 studies) were relevant. All were clinical trials. The definitions of disease flare or relapse in retrieved articles could be categorized into 3 broad themes: ( 1) composite definitions that include at least 2 different factors (eg, symptoms, severity duration, or treatment) ( 4 studies); ( 2) score thresholds or changes in severity scores 8 studies); and ( 3) behavioral definitions, such as the use of rescue therapy ( 3 studies). Only 1 investigative group ( 3 studies) used the same definition. None of the included studies were primarily designed to develop a definition of "flare." Evidence from other disciplines suggested at least 2 measures - totally controlled weeks and well-controlled weeks from asthma research - that could be used successfully in AD research.Conclusions: Defining an AD flare is a complex process, and this review has highlighted the need for standardization in defining measures of long-term disease control. We propose that a flare of AD be simply defined as an episode requiring escalation of treatment or seeking additional medical advice. Consideration should also be given to totally controlled weeks and well-controlled weeks to assess overall disease activity in patients with AD. Together, these definitions are intuitive, simple to use, and easy to understand. Future work is required to test the applicability of these recommendations in a variety of research settings.