Fumaric acid esters in the treatment of psoriasis (systemic review)

[Fred]

This is a summary of a  systemic review for the use of fumaric acid esters in the treatment of psoriasis.

Quote:

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Summary:
Fumaric acid esters (FAEs) are increasingly used as a systemic treatment for psoriasis, but there are still uncertainties regarding their suitability. The objective of this systematic review was to assess the evidence for the efficacy and safety of FAEs in psoriasis treatment.

A systematic literature search was performed in seven databases up to 17 August 2015. Inclusion criteria were studies that reported clinical effects of FAEs in patients with psoriasis without restrictions in study design, language or publication date. Methodological quality of randomized controlled trials (RCTs) and overall level of quality were assessed using the Cochrane risk of bias tool and the Grading of Recommendation, Assessment, Development and Evaluation approach, respectively.

A total of 68 articles were included. There were seven RCTs (total 449 patients) that had an unclear risk of bias and were too clinically heterogeneous to allow a meta-analysis. Overall, mean Psoriasis Area and Severity Index decreased by 42–65% following 12–16 weeks of treatment. There were 37 observational studies (a total of 3457 patients) that supported the RCT findings, but most were uncontrolled with a high risk of bias.

Commonly reported adverse events included gastrointestinal complaints and flushing, leading to treatment withdrawal in 6–40% of patients. Several case-reports described rare adverse events, such as renal Fanconi syndrome and progressive multifocal leukoencephalopathy. There was a lack of studies focusing on long-term use and comparisons with other treatments.

This review concluded that there is low-quality evidence to recommend the use of oral FAEs to treat plaque psoriasis in adult patients. Studies focusing on long-term safety and comparison with systemic psoriasis treatments could lead to a better understanding of the role of FAEs as a treatment for psoriasis.

Source: onlinelibrary.wiley.com

*Early view funding unknown.

[Caroline]

Of course I will not react.

It remains strange that in NL during 30 years a few thousands of patients get along very well, and than a scientific study suddenly concludes that nothing seems to be proven.

I really am curious on the funding.  
Thanks for the info though.

[jiml]

An interesting article thanks for posting it Fred

What amazes me with a study like this is that despite the drug being used for over 30years successfully in Germany, and yet they can't report on any good quality evidence

They seem to have covered a lot of studies and trials which again produced low quality evidence, or bias

And I agree that a long term study of the efficacy of the drug with controlled dosing and measured results would be helpful to dermatologists who often ignore the drug in favour of others

I'm glad that they concluded that there was evidence (albeit low quality ) to recommend the use of FAEs for the treatment of plaque psoriasis

[Fred]

Of course I will not react.

But you did.  

An interesting article thanks for posting it Fred

You're welcome. As you know I have roving reporters out there giving me news about psoriasis, and I'm only the messenger.  

[Caroline]

Of course I will not react.

But you did.  

No I didn't, you just think I did  

An interesting article thanks for posting it Fred

You're welcome. As you know I have roving reporters out there giving me news about psoriasis, and I'm only the messenger.  

Enough reason not to shoot you

[Fred]

Of course I will not react.

But you did.  

No I didn't, you just think I did  

An interesting article thanks for posting it Fred

You're welcome. As you know I have roving reporters out there giving me news about psoriasis, and I'm only the messenger.  

Enough reason not to shoot you