Background: psoriasis is a chronic and multisystemic inflammatory disease with predominantly skin and joint manifestations. It is characterized by an abnormal regulation of T cells and keratinocyte interaction. Its prevalence ranges between 0.09% to 5.1% in several countries. It mainly occurs before the age of 35 years and it is uncommon in children (0.71%). The significant impact of psoriasis on well-being suffered by affected individuals underpins the need for prompt, effective treatment, and long-term disease control. To our knowledge, there is one published quality assessment of clinical practice guidelines (CPGs) for the treatment of psoriasis, which evaluates CPGs published between 2006 to 2009. Several CPGs have been published/updated since 2009, hence it is necessary to develop an updated quality assessment of CPGs for the treatment of psoriasis.
Objectives: to systematically review CPGs for psoriasis treatment, and to assess: 1) methodological quality using the AGREE II tool; 2) change in CPG quality over time; 3) consistency of recommendations across CPGs.
Methods: we searched MEDLINE, Embase, LILACs and websites of guideline development agencies (e.g. governments and scientific societies). Two review authors (AA, CM) were calibrated for the selection process of CPGs by screening the same 20% of total records by title and abstract, after which, the Intraclass Correlation Coefficient between review authors was 0.9. The other 80% of total records was divided between the two review authors who independently assessed them. For full-text assessment, both review authors screened all documents. If review authors disagreed, a third review author (AV/JVAF) was involved and conflicts were solved by discussion. Included CPGs will be evaluated by all review authors using the AGREE II tool.
Preliminary results: we identified a total of 2812 records and 2762 remained after deduplication. After title and abstract screening, we included 28 records for full-text assessment and 16 CPGs for data extraction (Figure 1). Included CPGs were published in several languages, including English, Japanese, Spanish, German, Dutch and French. From the included CPGs, five addressed treatment of all types of psoriasis, six focused on treatment for plaque psoriasis, three addressed treatment for psoriatic arthritis, and two focused on treatment for pustular psoriasis.
To date, we have obtained further data from 12 out of the 16 CPGs. The 12 CPGs were developed in China (1), Italy (2), UK (2), Canada (1), Japan (2), USA (1), Germany (2), Spain (1) and the Netherlands (1). Organizations that developed the CPGs include: University (1), Professional Association/Society (9), Government (1), and Guideline Committee created for that purpose (1).
Conclusions: by evaluating the 16 included up-to-date CPGs for the treatment of psoriasis, this study contributes to better understanding of the quality of clinical recommendations that are given based on available evidence.
Patient involvement: not applicable