Summary of findings 7. Etretinate compared to PUVA therapy for chronic palmoplantar pustulosis.
| Etretinate compared to PUVA therapy for chronic palmoplantar pustulosis | ||||||
| Patient or population: chronic palmoplantar pustulosis Setting: not reported Intervention: etretinate Comparison: PUVA therapy | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with PUVA therapy | Risk with etretinate | |||||
| Proportion of participants cleared or almost cleared in the short term (12 weeks) | Study population | RR 11.20 (4.16 to 30.18) | 84 (1 RCT) | ⊕⊝⊝⊝ Very lowa | ‐ | |
| 63 per 1000 | 700 per 1000 (260 to 1000) | |||||
| Proportion of participants with adverse effects serious or severe enough to have caused withdrawal ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Proportion of participants with at least 50% improvement in their quality of life ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Proportion of participants achieving a 50% reduction in disease severity ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Proportion of participants without relapse in the long term ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Proportion of participants with adverse effects ‐ measured over 12 weeks | Study population | RR 11.54 (5.17 to 25.74) | 84 (1 RCT) | ⊕⊝⊝⊝ Very lowa | In the etretinate group, 2 participants had severe hair loss and 1 had severe drying of the mucosa. One‐third of participants developed mild erythema and scaling of healthy skin, and all had mild drying of the lips and nasal mucosa. In the oral PUVA therapy group, 3 participants had nausea and 2 had pruritus. | |
| 78 per 1000 | 902 per 1000 (404 to 1000) | |||||
| Ease of compliance to an intervention or a treatment ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; PUVA: combination of psoralens and long‐wave ultraviolet radiation; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence. High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded by three levels to very low‐quality evidence: two levels due to study limitations because of high risk of bias for blinding and incomplete outcome data, and one level due to imprecision because the comparison was assessed in a single study and the result had a very large confidence interval.