Intervenções para esclerodermia localizada: revisão sistemática

• Ano de defesa: 2016
• Autor(a) principal: Albuquerque, Julia Vajda de [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• dARK ID: ark:/48912/001300001kpdh
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Localized scleroderma; Morphea; Systematic review; Esclerodermia localizada; Morfeia; Revisão sistemática
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4411053; http://repositorio.unifesp.br/handle/11600/47203

Objective: Evaluate the effectiveness of interventions for treating individuals with localized scleroderma. Methods: We conducted a systematic review of randomized controlled trials published up to July 2016. We included individuals diagnosed with any form of localized scleroderma, treated with isolated or combined interventions, with any type of control. We searched the following databases: Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (via OVID, from 1946), EMBASE (via OVID, from 1974), LILACS (from 1982), and on registers of ongoing trials, besides the reference lists of included studies. Two authors independently assessed the eligibility and risk of bias of studies, and extracted data. Results: We included 13 randomized controlled trials. The treatment response with oral methotrexate (15 mg/m2, maximum 20 mg, once a week) after 12 months is 2.31 the response with placebo (risk ratio 2.31; 95% confidence interval 1.20 to 4.45; moderate-quality evidence; juvenile participants). The treatment with methotrexate for 12 months is favorable regarding reduction in the skin score rate (risk ratio -0.31; 95% confidence interval -0.35 to -0.27) and thermal percentage change (mean difference -32.30; 95% confidence interval -37.92 to -26.68; moderate-quality evidence). The treatment with oral hydroxychloroquine (200 mg, twice a day) reduces 2.30 points in the Visual Analogue Scale for pruritus in the lesions compared to methotrexate (15 mg, once a week), after three months (mean difference - 2.30; 95% confidence interval -3.25 to -1.35; moderate-quality evidence). The participants? satisfaction is higher in the lesions treated with fractional carbon dioxide laser then with low-dose ultraviolet-A1 light, after 10 weeks (mean difference 1.12; 95% confidence interval 0.80 to 1.44; moderate-quality evidence). The clinical response after 10 weeks in the lesions treated with fractional carbon dioxide laser is 2.67 the response low-dose ultraviolet-A1 light (risk ratio 2.67; 95% confidence interval 1.39 to 5.13 moderate-quality evidence). Conclusions: The current evidence for the treatment of localized scleroderma is limited and favors the treatment with methotrexate, hydroxychloroquine and fractional carbon dioxide laser. For high-quality evidence, multicenter randomized controlled trials with greater number of participants are still necessary.