Treatments for bulimia nervosa: a network meta-analysis

Background Bulimia nervosa (BN) is a severe eating disorder that can be managed using a variety of treatments including pharmacological, psychological, and combination treatments. We aimed to compare their effectiveness and to identify the most effective for the treatment of BN in adults. Methods A search was conducted in Embase, Medline, PsycINFO, and Central from their inception to July 2016. Studies were included if they reported on treatments for adults who fulfilled diagnostic criteria for BN. Only randomised controlled trials (RCTs) that examined available psychological, pharmacological, or combination therapies licensed in the UK were included. We conducted a network meta-analysis (NMA) of RCTs. The outcome analysed was full remission at the end of treatment. Results We identified 21 eligible trials with 1828 participants involving 12 treatments, including wait list. The results of the NMA suggested that individual cognitive behavioural therapy (CBT) (specific to eating disorders) was most effective in achieving remission at the end of treatment compared with wait list (OR 3.89, 95% CrI 1.19–14.02), followed by guided cognitive behavioural self-help (OR 3.81, 95% CrI 1.51–10.90). Inconsistency checks did not identify any significant inconsistency between the direct and indirect evidence. Conclusions The analysis suggested that the treatments that are most likely to achieve full remission are individual CBT (specific to eating disorders) and guided cognitive behavioural self-help, although no firm conclusions could be drawn due to the limited evidence base. There is a need for further research on the maintenance of treatment effects and the mediators of treatment outcome

A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris

BackgroundVarious treatments for acne vulgaris exist, but little is known about their comparative effectiveness by acne severity.ObjectivesTo identify best treatments for mild-to-moderate and moderate-to-severe acne, as determined by clinician-assessed morphological features.MethodsWe undertook a systematic review and network meta-analysis of randomised controlled trials (RCTs) assessing topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, published up to May 2020. Outcomes included percentage change in total lesion count from baseline, treatment discontinuation for any reason and due to side effects. Risk of bias was assessed using the Cochrane risk-of-bias tool, and bias-adjustment models. We report below effects versus placebo for treatments with ≥50 observations each.ResultsWe included 179 RCTs with ≈35,000 observations across 49 treatment classes. For mild-to-moderate acne, the most effective options for each treatment type were (mean difference, 95% credible intervals): topical pharmacological - combined retinoid with benzoyl peroxide [BPO] (26.16%, 16.75%-35.36%); physical – chemical peels, e.g. salicylic or mandelic acid (39.70%, 12.54%-66.78%) and photochemical therapy [combined blue/red light] (35.36%, 17.75%-53.08%). Oral pharmacological treatments (e.g. antibiotics, hormonal contraceptives) did not appear to be effective after bias adjustment. BPO and topical retinoids were less tolerated than placebo. For moderate-to-severe acne, the most effective options for each treatment type were: topical pharmacological - combined retinoid with lincosamide [clindamycin] (44.43%, 29.20%-60.02%); oral pharmacological - isotretinoin of total cumulative dose ≥120mg/kg/single course (58.09%, 36.99%-79.29%); physical - photodynamic therapy [light therapy enhanced by a photosensitizing chemical] (40.45%, 26.17%-54.11%); combined - BPO with topical retinoid and oral tetracycline (43.53%, 29.49%-57.70%). Topical retinoids and oral tetracyclines were less tolerated than placebo. Quality of included RCTs was moderate-to-very low, with evidence of inconsistency between direct and indirect evidence. Uncertainty in findings was high, in particular for chemical peels, photochemical and photodynamic therapies. However, conclusions were robust to potential bias in the evidence.ConclusionsTopical pharmacological treatment combinations, chemical peels and photochemical therapy were most effective for mild-to-moderate acne. Topical pharmacological treatment combinations, oral antibiotics combined with topical pharmacological treatments, oral isotretinoin, and photodynamic therapy were most effective for moderate-to-severe acne. Further research is warranted for chemical peels, photochemical and photodynamic therapies for which evidence was more limited

Diagnosis and management of pancreatic cancer in adults: A summary of guidelines from the UK National Institute for Health and Care Excellence

To enable standardisation of care of pancreatic cancer patients and facilitate improvement in outcome, the United Kingdom's National Institute for Health and Care Excellence (NICE) developed a clinical guideline for the diagnosis and management of pancreatic cancer in adults. Systematic literature searches, systematic review and meta-analyses were undertaken. Recommendations were drafted on the basis of the group's interpretation of the best available evidence of clinical and cost effectiveness. There was patient involvement and public consultation. Recommendations were made on: diagnosis; staging; monitoring of inherited high risk; psychological support; pain; nutrition management; and the specific management of people with resectable-, borderline-resectable- and unresectable-pancreatic cancer. The guideline committee also made recommendations for future research into neoadjuvant therapy, cachexia interventions, minimally invasive pancreatectomy, pain management and psychological support needs. These NICE guidelines aim to promote best current practice and support and stimulate research and innovation in pancreatic cancer.</p