Efficacy and safety of antiscabietic agents: A systematic review and network meta-analysis of randomized controlled trials

Publication date: Available online 14 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Kunlawat Thadanipon, Thunyarat Anothaisintawee, Sasivimol Rattanasiri, Ammarin Thakkinstian, John Attia

Abstract

Background

Many drugs have been used to treat scabies, but it is unclear which of them is the most efficacious.

Objective

To evaluate the comparative efficacy and safety of antiscabietic agents.

Methods

Systematic review of randomized controlled trials was conducted. Direct and network meta-analyses were applied to 13 antiscabietic agents on 3 outcomes (cure, persistent itching, and adverse events). Their probability of having highest efficacy and safety was estimated and ranked.

Results

Network meta-analysis based on 52 trials in 9917 patients indicated that permethrin (the reference treatment) had significantly higher cure rate than sulfur, malathion, lindane, crotamiton, and benzyl benzoate. Permethrin+oral ivermectin combination had non-significantly higher cure rate than permethrin. Permethrin+oral ivermectin combination, topical ivermectin, and synergized pyrethrins were the treatment ranked highest in terms of cure, persistent itching, and adverse events, respectively. Based on clusterd ranking, permethrin, oral ivermectin, and synergized pyrethrins seemed to retain balance between cure and adverse events.

Limitations

There are small numbers of trials and patients in some comparisons, and high risk of bias in some trials.

Conclusion

There is no one treatment that ranked highest in all aspects. Physicians should consider the drug's efficacy and safety profiles, along with ease of administration.

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