Quality Assessment of Clinical Practice Guidelines on the Treatment of Psoriasis Using the AGREE II Tool. / Evaluación de la calidad de guías de práctica clínica para el tratamiento de psoriasis mediante la herramienta AGREE II.

BACKGROUND: Clinical practice guidelines (CPGs) are designed to help health professionals provide patients with excellent medical care. The last critical appraisal of CPGs on the treatment of psoriasis evaluated publications up to 2009, but several new guidelines have been published since and their methodological quality remains unclear. OBJECTIVE: The aim of this study was to systematically evaluate the quality of CPGs on the treatment of psoriasis published between 2010 and 2020 using the Appraisal Guidelines Research and Evaluation II (AGREE II) tool. MATERIAL AND METHODS: We searched for relevant CPGs in MEDLINE, Embase, and LILACS (Latin American and Caribean Health Sciences Literature) as well as in the gray literature. Two reviewers working independently selected the guidelines for analysis and extracted the relevant data. Each guideline was then assessed using the AGREE II instrument by 5 reviewers, also working independently. RESULTS: Nineteen CPGs met the inclusion criteria and most of them had been produced in high-income countries. The mean (SD) domain scores were 84.9% (14.7%) for scope and purpose, 65.5% (19.3%) for stakeholder involvement, 66.7% (15.6%) for rigor of development, 72.8% (16.8%) for clarity of presentation, 46.6% (21.7%) for applicability, and 57.0% (30.4%) for editorial independence. CONCLUSIONS: Although about three-quarters of the CPGs assessed were judged to be of high quality and over half were recommended for use in clinical practice, standards of guideline development need to be raised to improve CPG quality, particularly in terms of applicability and editorial independence, which had the lowest scores in our evaluation.

Evaluación de la calidad de guías de práctica clínica para el tratamiento de psoriasis mediante la herramienta AGREE II / Quality Assessment of Clinical Practice Guidelines on the Treatment of Psoriasis Using the AGREE II Tool

Introducción: Las guías de práctica clínica (GPCs) se han desarrollado para apoyar a los profesionales de la salud a brindar una excelente atención médica a sus pacientes. Varias GPCs para el tratamiento de psoriasis se han desarrollado desde la última evaluación de calidad de GPCs publicada en 2009 y hasta el momento su calidad metodológica es poco clara. Objetivo: Evaluar sistemáticamente la calidad de GPCs para el tratamiento de psoriasis publicadas en el periodo de 2010-2020, utilizando el instrumento Appraisal Guidelines Research and Evaluation (AGREE II). Material y métodos: Se realizaron búsquedas de GPCs en bases de datos, incluyendo MEDLINE, Embase, LILACS y en la literatura gris. La selección de GPCs y la extracción de datos se realizó de forma independiente por dos revisores. Cinco revisores, aparte, evaluaron las GPCs usando el instrumento AGREE II. Resultados: Diez y nueve GPCs cumplieron con los criterios de inclusión, en su mayoría desarrolladas en países de altos ingresos. Las puntuaciones medias de los dominios fueron: alcance y propósito (84,9% ± 14,7%), participación de las partes interesadas (65,5% ± 19,3%), rigor del desarrollo (66,7% ± 15,6%), claridad de presentación (72,8% ± 16,8%), aplicabilidad (46,6% ± 21,7%), e independencia editorial (57,0% ± 30,4%). Conclusiones: A pesar de que tres cuartos del total de GPCs incluidas fueron clasificadas como de alta calidad y más de la mitad de ellas se recomendaron para la práctica clínica, el desarrollo de las GPCs todavía debe optimizarse para mejorar su calidad. Especialmente en su aplicabilidad e independencia editorial, los cuales fueron los dominios con la puntuación más baja (AU)

Background: Clinical practice guidelines (CPGs) are designed to help health professionals provide patients with excellent medical care. The last critical appraisal of CPGs on the treatment of psoriasis evaluated publications up to 2009, but several new guidelines have been published since and their methodological quality remains unclear. Objective: The aim of this study was to systematically evaluate the quality of CPGs on the treatment of psoriasis published between 2010 and 2020 using the Appraisal Guidelines Research and Evaluation II (AGREE II) tool. Material and methods: We searched for relevant CPGs in MEDLINE, Embase, and LILACS (Latin American and Caribean Health Sciences Literature) as well as in the gray literature. Two reviewers working independently selected the guidelines for analysis and extracted the relevant data. Each guideline was then assessed using the AGREE II instrument by 5 reviewers, also working independently. Results: Nineteen CPGs met the inclusion criteria and most of them had been produced in high-income countries. The mean (SD) domain scores were 84.9% (14.7%) for scope and purpose, 65.5% (19.3%) for stakeholder involvement, 66.7% (15.6%) for rigor of development, 72.8% (16.8%) for clarity of presentation, 46.6% (21.7%) for applicability, and 57.0% (30.4%) for editorial independence. Conclusions: Although about three-quarters of the CPGs assessed were judged to be of high quality and over half were recommended for use in clinical practice, standards of guideline development need to be raised to improve CPG quality, particularly in terms of applicability and editorial independence, which had the lowest scores in our evaluation (AU)

[Translated article] Quality Assessment of Clinical Practice Guidelines on the Treatment of Psoriasis Using the AGREE II Tool / Evaluación de la calidad de guías de práctica clínica para el tratamiento de psoriasis mediante la herramienta AGREE II

Background: Clinical practice guidelines (CPGs) are designed to help health professionals provide patients with excellent medical care. The last critical appraisal of CPGs on the treatment of psoriasis evaluated publications up to 2009, but several new guidelines have been published since and their methodological quality remains unclear. Objective: The aim of this study was to systematically evaluate the quality of CPGs on the treatment of psoriasis published between 2010 and 2020 using the Appraisal Guidelines Research and Evaluation II (AGREE II) tool. Material and methods: We searched for relevant CPGs in MEDLINE, Embase, and LILACS (Latin American and Caribean Health Sciences Literature) as well as in the gray literature. Two reviewers working independently selected the guidelines for analysis and extracted the relevant data. Each guideline was then assessed using the AGREE II instrument by 5 reviewers, also working independently. Results: Nineteen CPGs met the inclusion criteria and most of them had been produced in high-income countries. The mean (SD) domain scores were 84.9% (14.7%) for scope and purpose, 65.5% (19.3%) for stakeholder involvement, 66.7% (15.6%) for rigor of development, 72.8% (16.8%) for clarity of presentation, 46.6% (21.7%) for applicability, and 57.0% (30.4%) for editorial independence. Conclusions: Although about three-quarters of the CPGs assessed were judged to be of high quality and over half were recommended for use in clinical practice, standards of guideline development need to be raised to improve CPG quality, particularly in terms of applicability and editorial independence, which had the lowest scores in our evaluation (AU)

Introducción: Las guías de práctica clínica (GPCs) se han desarrollado para apoyar a los profesionales de la salud a brindar una excelente atención médica a sus pacientes. Varias GPCs para el tratamiento de psoriasis se han desarrollado desde la última evaluación de calidad de GPCs publicada en 2009 y hasta el momento su calidad metodológica es poco clara. Objetivo: Evaluar sistemáticamente la calidad de GPCs para el tratamiento de psoriasis publicadas en el periodo de 2010-2020, utilizando el instrumento Appraisal Guidelines Research and Evaluation (AGREE II). Material y métodos: Se realizaron búsquedas de GPCs en bases de datos, incluyendo MEDLINE, Embase, LILACS y en la literatura gris. La selección de GPCs y la extracción de datos se realizó de forma independiente por dos revisores. Cinco revisores, aparte, evaluaron las GPCs usando el instrumento AGREE II. Resultados: Diez y nueve GPCs cumplieron con los criterios de inclusión, en su mayoría desarrolladas en países de altos ingresos. Las puntuaciones medias de los dominios fueron: alcance y propósito (84,9% ± 14,7%), participación de las partes interesadas (65,5% ± 19,3%), rigor del desarrollo (66,7% ± 15,6%), claridad de presentación (72,8% ± 16,8%), aplicabilidad (46,6% ± 21,7%), e independencia editorial (57,0% ± 30,4%). Conclusiones: A pesar de que tres cuartos del total de GPCs incluidas fueron clasificadas como de alta calidad y más de la mitad de ellas se recomendaron para la práctica clínica, el desarrollo de las GPCs todavía debe optimizarse para mejorar su calidad. Especialmente en su aplicabilidad e independencia editorial, los cuales fueron los dominios con la puntuación más baja (AU)

Fotoféresis extracorpórea en enfermedad injerto contra huésped en una población pediátrica / Extracorporeal Photopheresis in Pediatric Graft-vs-Host Disease

Antecedentes La fotoféresis extracorpórea (FEC) es una terapia inmunomoduladora indicada para la enfermedad injerto contra huésped (EICH) en adultos y niños, no obstante, existen pocos estudios en esta última población. Objetivo Describir las características demográficas, la respuesta clínica, los efectos adversos y la evolución de los pacientes pediátricos con EICH aguda (EICH-a) y EICH crónica (EICH-c) tratados con FEC. Materiales y métodos Se incluyeron todos los pacientes con EICH-a y EICH-c sometidos a tratamiento con FEC entre enero de 2012 y diciembre de 2018 en el Servicio de Dermatología del Hospital Italiano de Buenos Aires. Se utilizó el sistema UVAR-XTS™ en 2 pacientes y el CELLEX™ en el resto, con 2 sesiones por semana y reevaluación al mes en EICH-a, 2 sesiones cada 2 semanas con reevaluación a los 3 meses en EICH-c, y en ambos finalización según respuesta. Resultados Evaluamos 9 pacientes pediátricos con EICH refractaria, dependiente y/o resistente a corticoides sistémicos tratados con FEC. Siete pacientes fueron respondedores y 2 no respondedores. La piel presentó respuesta completa (RC) en 1/9 y respuesta parcial en 7/9 pacientes, el hígado, el sistema gastrointestinal y las mucosas presentaron RC en 3/5, 1/2 y 4/5 pacientes, respectivamente. Dos pacientes fallecieron durante el periodo estudiado. Conclusión La FEC es una buena opción terapéutica para los pacientes pediátricos con EICH aguda y crónica (AU)

Background Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. Objective To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. Material and methods We included all pediatric patients with acute or chronic GVHD treated with ECP by the Dermatology Department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. Results We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. Conclusion ECP is a good treatment option for pediatric patients with acute or chronic GVHD (AU)

Extracorporeal Photopheresis in Pediatric Graft-vs-Host Disease.

BACKGROUND: Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. OBJECTIVE: To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. MATERIAL AND METHODS: We included all pediatric patients with acute or chronic GVHD treated with ECP by the dermatology department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. RESULTS: We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. CONCLUSION: ECP is a good treatment option for pediatric patients with acute or chronic GVHD.

Extracorporeal Photopheresis in Pediatric Graft-vs-Host Disease. / Fotoféresis extracorpórea en enfermedad injerto contra huésped en una población pediátrica.

BACKGROUND: Extracorporeal photopheresis (ECP) is an immunomodulatory therapy used to treat graft-vs-host disease (GVHD) in adults and children. Few studies have examined its use in children. OBJECTIVE: To describe demographic characteristics, clinical response, adverse effects, and outcomes in a series of pediatric patients with acute or chronic GVHD treated with ECP. MATERIAL AND METHODS: We included all pediatric patients with acute or chronic GVHD treated with ECP by the Dermatology Department of Hospital Italiano de Buenos Aires between January 2012 and December 2018. We used the UVAR-XTS™ system (2 patients) and the CELLEX system (7 patients). Patients with acute GVHD received 2 sessions a week and were reassessed at 1 month, while those with chronic GVHD received 2 sessions every 2 weeks and were reassessed at 3 months. Treatment duration in both scenarios varied according to response. RESULTS: We evaluated 9 pediatric patients with corticosteroid-refractory, -dependent, and/or -resistant GVHD treated with ECP. Seven responded to treatment and 2 did not. Response was complete in 1 of the 9 patients with skin involvement and partial in 7. Complete response rates for the other sites of involvement were 60% (3/5) for the liver, 50% (1/2) for the gastrointestinal system, and 80% (4/5) for mucous membranes. Two patients died during the study period. CONCLUSION: ECP is a good treatment option for pediatric patients with acute or chronic GVHD.