AB0773 Interventions for morphea: a cochrane systematic review
Authors: J.V. de Albuquerque, B.NG. Andriolo, M.RA. Vasconcellos, V.T. Civile, A. Lyddiatt, V.FM. Trevisani
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Morphea is a chronic inflammatory and fibrosing disorder usually limited to the skin and underlying tissues. It is an immune-mediated disease in which excess synthesis and deposition of collagen in the skin and connective tissues results in hardened cutaneous areas. <h3>Objectives</h3> To assess the effectiveness and safety of treatments for individuals with any form of morphea. <h3>Methods</h3> We searched the following databases up to March 2017: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, and five trials registry databases. We checked the reference lists of included studies for further references to relevant randomised controlled trials. We included randomised controlled trials assessing the effects of topical, intralesional, or systemic treatments for morphea (isolated or combined). Two authors independently assessed study eligibility, extracted data, assessed risk of bias and performed analyses. A third author settled any disagreements. <h3>Results</h3> We included 13 trials, totalling 426 participants. There were both juvenile and adult participants (mostly women). The majority had limited morphea, followed by linear morphea. The studies evaluated heterogenous therapies for morphea, covering a wide range of comparisons. Thus, we could not pool data from the studies in a meta-analysis. Six studies investigated topical medications, two evaluated intralesional medications, and five investigated systemic medications. Regarding our primary outcome global improvement of disease activity or damage: - The number of juvenile participants with a significant clinical response was higher with oral methotrexate plus oral prednisone than with placebo plus oral prednisone (RR 2.31, 95% CI 1.20 to 4.45, after the 12 month treatment; NNT 3; low-certainty evidence); - We are uncertain whether fractional carbon dioxide laser and the combination of acupuncture, hot herbal compress and moxibustion plus Centella triterpenes tablets and vitamin E may reduce this outcome, as the certainty of the evidence was very low; - We found no differences in the MSS score between the following comparisons (very low-certainty evidence): oral hydroxychloroquine plus topical corticosteroid versus oral methotrexate plus folic acid and topical corticosteroid; and medium-dose ultraviolet A-1 (50 J/cm<sup>2</sup>) versus low-dose ultraviolet A-1 (20 J/cm<sup>2</sup>) phototherapy versus narrowband UVB. We are uncertain regarding adverse effects of interventions as the certainty of the evidence was very low. However, participants reported marked pain and pruritus during fractional carbon dioxide laser therapy, and had mild tanning after ultraviolet A-1 phototherapy. <h3>Conclusions</h3> There is a lack of high-certainty evidence for the treatment of morphea, and the effectiveness and safety of the interventions are unclear. Low-certainty evidence supports the effectiveness of oral methotrexate plus oral prednisone for treating juvenile morphea. More studies are necessary to assess the effectiveness and safety of interventions for morphea. <h3>Acknowledgements</h3> This abstract is based on a draft and pre-peer review version of a Cochrane Review. Upon completion and approval, the final version is expected to be published in the <i>Cochrane Database of Systematic Reviews</i> (www.cochranelibrary.com). <h3>Disclosure of Interest</h3> None declared