PMID- 36971254
OWN - NLM
STAT- MEDLINE
DCOM- 20240219
LR  - 20240219
IS  - 1365-2133 (Electronic)
IS  - 0007-0963 (Linking)
VI  - 190
IP  - 3
DP  - 2024 Feb 16
TI  - A systematic review of 454 randomized controlled trials using the Dermatology 
      Life Quality Index: experience in 69 diseases and 43 countries.
PG  - 315-339
LID - 10.1093/bjd/ljad079 [doi]
AB  - BACKGROUND: Over 29 years of clinical application, the Dermatology Life Quality 
      Index (DLQI) has remained the most used patient-reported outcome (PRO) in 
      dermatology due to its robustness, simplicity and ease of use. OBJECTIVES: To 
      generate further evidence of the DLQI's utility in randomized controlled trials 
      (RCTs) and to cover all diseases and interventions. METHODS: The methodology 
      followed PRISMA guidelines and included seven bibliographical databases, 
      searching articles published from 1 January 1994 until 16 November 2021. Articles 
      were reviewed independently by two assessors, and an adjudicator resolved any 
      opinion differences. RESULTS: Of 3220 screened publications, 454 articles meeting 
      the eligibility criteria for inclusion, describing research on 198 190 patients, 
      were analysed. DLQI scores were primary endpoints in 24 (5.3%) of studies. Most 
      studies were of psoriasis (54.1%), although 69 different diseases were studied. 
      Most study drugs were systemic (85.1%), with biologics comprising 55.9% of all 
      pharmacological interventions. Topical treatments comprised 17.0% of total 
      pharmacological interventions. Nonpharmacological interventions, mainly laser 
      therapy and ultraviolet radiation treatment, comprised 12.2% of the total number 
      of interventions. The majority of studies (63.7%) were multicentric, with trials 
      conducted in at least 42 different countries; 40.2% were conducted in multiple 
      countries. The minimal clinically importance difference (MCID) was reported in 
      the analysis of 15.0% of studies, but only 1.3% considered full score meaning 
      banding of the DLQI. Forty-seven (10.4%) of the studies investigated statistical 
      correlation of the DLQI with clinical severity assessment or other PRO/quality of 
      life tools; and 61-86% of studies had within-group scores differences greater 
      than the MCID in 'active treatment arms'. The Jadad risk-of-bias scale showed 
      that bias was generally low, as 91.8% of the studies had Jadad scores of >/= 3; 
      only 0.4% of studies showed a high risk of bias from randomization. Thirteen per 
      cent had a high risk of bias from blinding and 10.1% had a high risk of bias from 
      unknown outcomes of all participants in the studies. In 18.5% of the studies the 
      authors declared that they followed an intention-to-treat protocol; imputation 
      for missing DLQI data was used in 34.4% of studies. CONCLUSIONS: This systematic 
      review provides a wealth of evidence of the use of the DLQI in clinical trials to 
      inform researchers' and -clinicians' decisions for its further use. 
      Recommendations are also made for improving the reporting of data from future 
      RCTs using the DLQI.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of British 
      Association of Dermatologists.
FAU - Vyas, Jui
AU  - Vyas J
AUID- ORCID: 0000-0003-2839-2651
AD  - Centre for Medical Education.
FAU - Johns, Jeffrey R
AU  - Johns JR
AUID- ORCID: 0000-0002-1628-4306
AD  - Division of Infection and Immunity, School of Medicine, Cardiff University, 
      Cardiff, UK.
FAU - Ali, Faraz M
AU  - Ali FM
AUID- ORCID: 0000-0002-4184-2023
AD  - Division of Infection and Immunity, School of Medicine, Cardiff University, 
      Cardiff, UK.
FAU - Singh, Ravinder K
AU  - Singh RK
AD  - Division of Infection and Immunity, School of Medicine, Cardiff University, 
      Cardiff, UK.
FAU - Ingram, John R
AU  - Ingram JR
AUID- ORCID: 0000-0002-5257-1142
AD  - Division of Infection and Immunity, School of Medicine, Cardiff University, 
      Cardiff, UK.
FAU - Salek, Sam
AU  - Salek S
AUID- ORCID: 0000-0002-4612-5699
AD  - School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
FAU - Finlay, Andrew Y
AU  - Finlay AY
AUID- ORCID: 0000-0003-2143-1646
AD  - Division of Infection and Immunity, School of Medicine, Cardiff University, 
      Cardiff, UK.
LA  - eng
GR  - Division of Infection and Immunity/
GR  - School of Medicine/
GR  - Cardiff University/
PT  - Journal Article
PT  - Systematic Review
PL  - England
TA  - Br J Dermatol
JT  - The British journal of dermatology
JID - 0004041
SB  - IM
CIN - Br J Dermatol. 2024 Feb 16;190(3):e28. PMID: 38366832
MH  - Humans
MH  - *Dermatology
MH  - Randomized Controlled Trials as Topic
MH  - *Psoriasis/drug therapy
MH  - *Ultraviolet Therapy
MH  - Quality of Life
COIS- Conflicts of interest J.V. has participated in an Advisory Board for Amgen, has 
      received payment or honoraria from L'Oreal and support from UCB Pharma for 
      attending meetings. F.M.A. has received honoraria from AbbVie, Janssen, LEO 
      Pharma, Lilly Pharmaceuticals, L'Oreal, Novartis and UCB. His department receives 
      income from royalties from the Dermatology Life Quality Index (DLQI) and related 
      instruments. J.R.I. receives a stipend as Editor-in-Chief of the British Journal 
      of Dermatology and an authorship honorarium from UpToDate. He is a consultant for 
      Boehringer Ingelheim, ChemoCentryx, Citryll, Novartis and UCB Pharma, and has 
      served on advisory boards for Insmed, Kymera Therapeutics and Viela Bio. He is 
      co--copyright holder of HiSQOL, Investigator Global Assessment and Patient Global 
      Assessment instruments for hidradenitis suppurativa. His department receives 
      income from royalties from the DLQI and related instruments. S.S. has received an 
      unrestricted educational grant from GSK, is a consultant for Novo Nordisk and 
      produces educational materials for AbbVie. A.Y.F. is joint copyright owner of the 
      DLQI. Cardiff University receives royalties from some use of the DLQI; A.Y.F. 
      receives a proportion of these under standard university policy. J.R.J. and 
      R.K.S. report no conflicts of interest.
EDAT- 2023/03/28 06:00
MHDA- 2024/02/19 06:43
CRDT- 2023/03/27 07:02
PHST- 2022/08/25 00:00 [received]
PHST- 2023/01/31 00:00 [revised]
PHST- 2023/03/14 00:00 [accepted]
PHST- 2024/02/19 06:43 [medline]
PHST- 2023/03/28 06:00 [pubmed]
PHST- 2023/03/27 07:02 [entrez]
AID - 7086906 [pii]
AID - 10.1093/bjd/ljad079 [doi]
PST - ppublish
SO  - Br J Dermatol. 2024 Feb 16;190(3):315-339. doi: 10.1093/bjd/ljad079.