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- Title
Treatment following an evidence-based algorithm versus individualised symptom-oriented treatment for atopic eczema. A randomised controlled trial.
- Authors
Schmitt, Jochen; Meurer, Michael; Schwanebeck, Uta; Grählert, Xina; Schäkel, Knut; Grahlert, Xina; Schakel, Knut
- Abstract
<bold>Background: </bold>Evidence-based treatment algorithms, successfully established for asthma, are missing for atopic eczema (AE).<bold>Objectives: </bold>To investigate whether treatment according to an evidence-based algorithm is an effective and applicable concept for the management of AE.<bold>Methods: </bold>Based on a systematic literature review, we developed an evidence-based severity-score-oriented treatment algorithm for AE and compared its effectiveness to that of an individualised symptom-oriented treatment (individual therapy) in a randomised controlled trial. Sixty-three participants were randomised to algorithm (n = 32) or individual therapy (n = 31) and treated accordingly for 12 months. Study end points included difference between baseline SCORAD and mean SCORAD under treatment (primary end point), quality of life and treatment utilisation. Analysis was by intention to treat (registration: Clinical Trials.gov:NCT00148746).<bold>Results: </bold>No statistically significant differences in clinical or subjective response were observed between groups. Treatment following the algorithm and individual treatment both effectively controlled AE. Mean SCORAD reductions were 47% (95% confidence interval, CI = 38-55; algorithm) and 42% (95% CI = 29-54; individual). Clinical response was paralleled by improved quality of life in both groups. Physicians adhered to the algorithm option in 93% of their treatment decisions.<bold>Conclusion: </bold>Treatment following an evidence-based algorithm is an effective and applicable concept for the management of AE but does not show clear advantages compared to individualised treatment in a dermatological setting.
- Subjects
GERMANY; ATOPIC dermatitis treatment; THERAPEUTIC use of glucocorticoids; IMMUNOSUPPRESSIVE agents; ALGORITHMS; ATOPIC dermatitis; COMBINATION drug therapy; COMPARATIVE studies; CONFIDENCE intervals; RESEARCH methodology; MEDICAL cooperation; PHOTOTHERAPY; QUALITY of life; RESEARCH; EVIDENCE-based medicine; EVALUATION research; RANDOMIZED controlled trials; RETROSPECTIVE studies; SEVERITY of illness index
- Publication
Dermatology (10188665), 2008, Vol 217, Issue 4, p299
- ISSN
1018-8665
- Publication type
journal article
- DOI
10.1159/000151355