Treatments for Pyoderma Gangrenosum: A Systematic Review and Single-Arm Meta-Analysis of Systemic Therapies

Area of Science:

• Dermatology
• Clinical Pharmacology
• Evidence Synthesis

Background:

• Pyoderma gangrenosum (PG) is a severe neutrophilic dermatosis with high morbidity and mortality.
• Current treatment strategies lack consensus and require further investigation for efficacy and safety.

Purpose of the Study:

• To systematically review and synthesize clinical evidence on the efficacy and safety of various treatments for Pyoderma gangrenosum.
• To analyze outcomes including complete healing, recurrence, treatment failure, and adverse events.

Main Methods:

• Systematic search of five databases (ClinicalTrials.gov, CENTRAL, Embase, PubMed, Scopus) up to May 2024.
• Inclusion of 20 interventional studies (RCTs, cohort, open-label) with risk of bias assessment.
• Single-arm meta-analysis of systemic immunomodulators to evaluate treatment outcomes.

Main Results:

• Pooled complete healing proportion across 11 studies was 0.59 (95% CI: 0.41-0.74).
• Pooled recurrence rate was 0.30 (95% CI: 0.20-0.41), and treatment failure was 0.36 (95% CI: 0.24-0.49).
• Serious adverse events pooled proportion was 0.10 (95% CI: 0.05-0.19).

Conclusions:

• Treatment efficacy for Pyoderma gangrenosum varies significantly, with common recurrence and treatment failure.
• Heterogeneity in study methods and limited sample sizes hinder robust research.
• There is a critical need for improved outcome measures and novel therapeutic options for PG patients.