Quality assessment
In selected RCTs quality was assessed by the Cochrane Collaboration Risk-of-Bias Instrument.36 Quality assessment was performed by two independent authors and any disagreements were discussed and resolved by a third reviewer.A majority of RCTs were double-blind and were conducted across multiple centers, we rated 3 out of 24 RCTs as “high risk” because they had blinding of bias24 27,30.The more details on quality assessment results are shown in Supplemental figure 2a–b.
Primery efficacy oftopical therapies at 4–12 weeks
All RCTs that reported the number of patients who achieved PGA0/1 or IGA0/1 were included in the network.NAM showed that all treatments were significantly more effective than vehicle,expect tofacitinib cream(OR1.39,95%CI0.88 to 2.19).(Table 1)According to the SUCRA, Cumulative ranking probabilities for treatment success showed that Cal/BD performed best(SUCRA 97.2),followed by tapinarof cream(SUCRA 85.7) and betamethasone(SUCRA 75.6) ( Supplemental table 4). Compared with vehicle, Cal/BD had the highest treatment success rate(OR 10.35,95%CI7.40 to 14.48) followed by tapinarof cream(OR 8.28,95%CI 5.35 to 12.82)( Supplemental figure 3a).No evidence of inconsisitency was showed for primery efficacy.(P= 0.405 )
Most effective treatment is Cal/BD,formulation fall mainly into five categories: PADTMTechnology cream(PAD-cream),topical suspension(TS),ointment, aerosol foam(AF),gel. The subgroup analysis according to drug formulation, according to the SUCRA, aerosol foam(96.3) was ranked the best among the five formulation. (Supplemental table 5).