Treatment following an evidence-based algorithm versus individualised symptom-oriented treatment for atopic eczema. A randomised controlled trial.
BACKGROUND
Evidence-based treatment algorithms, successfully established for asthma, are missing for atopic eczema (AE).


OBJECTIVE
To investigate whether treatment according to an evidence-based algorithm is an effective and applicable concept for the management of AE.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Schmitt
Jochen
J
Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany. jochen.schmitt@uniklinikum-dresden.de
Meurer
Michael
M
Schwanebeck
Uta
U
Grahlert
Xina
X
Schakel
Knut
K
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003876:Dermatitis, Atopic / Q000188:drug therapy / Q000628:therapy*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010789:Phototherapy / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index
D005938:Glucocorticoids; D007166:Immunosuppressive Agents