背景:蠕形螨与一些炎症性疾病如酒渣鼻和眼睑炎有关,对免疫缺陷或免疫抑制患者可能有害,尤其是在使用dupilumab等生物制剂的患者中。为了客观观察不同的抗蠕形螨策略,我们进行了这项研究,基于具有量化的蠕形螨数据的介入性临床证据。
方法:我们使用了PubMed,Embase,ClinicalTrials.gov,Medline,和国际临床试验注册平台(ICTRP)作为数据库。为了评估偏见的风险,使用RoB2和ROBINS-I工具。根据GRADE指南评估证据的确定性。此外,比较不同策略在不同时间段(0-1、1-2、2-3、>3个月)的效应大小(ESs),以及蠕形螨下降率。
结果:在数据库中确定了1,618项研究,其中21种包括在最终的定量合成中。这些研究中的干预措施包括伊维菌素,茶树油(TTO),氯菊酯,Crotamiton,甲硝唑,光疗法,联合疗法,和其他疗法。在0-1个月期间,ES从0.07(清洁剂)到1.95(全身性伊维菌素-甲硝唑)不等。在1-2个月内,ES从0.88(局部氯菊酯)到4.40(局部伊维菌素)不等。在2-3个月内,ES从0.79(局部氯菊酯)到8.37(局部伊维菌素)不等。在三个月的时间里,ES从0.59(局部氯菊酯)到2.25(强脉冲光[IPL])不等。在蠕形螨下降率方面,局部伊维菌素,TTO,氯菊酯,IPL,婴儿洗发水减少了近100%。报告的不良事件大多为轻度,在任何研究中均未报告严重不良事件。
结论:我们发现伊维菌素(局部和全身),伊维菌素-甲硝唑(局部),和TTO(局部)是有希望的抗蠕形螨干预措施。除了传统的药物治疗,光疗法,尤其是IPL和皮肤清洁,也可以认为是控制蠕形螨感染的有效方法。
BACKGROUND: Demodex mites are related to some inflammatory diseases such as rosacea and blepharitis and could be harmful in patients with immunodeficiency or immunosuppression, especially notable in patients using biologic like dupilumab. In order to have an objective observation of different anti-Demodex strategies, we conducted this study, based on interventional clinical evidence with quantified Demodex mite data.
METHODS: We used the PubMed, Embase, ClinicalTrials.gov, Medline, and International Clinical Trials Registry Platform (ICTRP) as databases. To assess the risk of bias, the RoB2 and ROBINS-I tools were used. The certainty of evidence was assessed following the GRADE guideline. Furthermore, the effect sizes (ESs) of different strategies were compared in different time periods (0-1, 1-2, 2-3, >3 months), as well as Demodex decrease rates.
RESULTS: 1,618 studies were identified in the databases, with 21 of which included in the final quantitative synthesis. Interventions in these studies included ivermectin, tea tree oil (TTO), permethrin, crotamiton, metronidazole, light therapies, combined therapies, and other therapies. During 0-1 month, the ES varied from 0.07 (cleanser) to 1.95 (systemic ivermectin-metronidazole). During 1-2 months, the ES varied from 0.88 (topical permethrin) to 4.40 (topical ivermectin). During 2-3 months, the ES varied from 0.79 (topical permethrin) to 8.37 (topical ivermectin). During the time of 3 months, the ES varied from 0.59 (topical permethrin) to 2.25 (intense pulsed light [IPL]). In terms of Demodex decrease rates, topical ivermectin, TTO, permethrin, IPL, and baby shampoo had achieved a nearly 100% decrease. The reported adverse events were mostly mild, without severe adverse events reported in any of the studies.
CONCLUSIONS: We found ivermectin (topical and systemic), ivermectin-metronidazole (topical), and TTO (topical) are promising anti-Demodex interventions. In addition to traditional pharmacotherapy, light therapies, especially IPL and skin cleansing, could also be considered as effective methods to control Demodex mite infestation.