FCT 11 : Systematic review and quality analysis of articles on the efficacy of topical DPCP treatment in alopecia areata

Background: The effectiveness of topical diphenylcyclopropenone (DPCP) immunotherapy in patients with severe and refractory alopecia areata (AA) has been demonstrated. However, the response rates varied greatly and this variability may be due to the differences in the number of patients, severity of AA, disease duration before treatment, and evaluation method undertaken in the various studies. Objectives: To compare the efficacy of topical DPCP treatment in AA by performing a systematic review of RCTs and open-label trials Methods: Databases of PubMed, EMBASE, and the Cochrane Library were searched between 1976 and 2015. Studies published in English that reported the efficacy of topical DPCP treatment in AA were selected. Results: Sixteen studies were finally included. Several factors including different study design, variable descriptions of efficacy, and a lack of standardized data collection have been responsible for the heterogeneity present in this review. Clinical response evaluated on the basis of percentage of hair regrowth on the scalp. In this analysis, response rate of DPCP treatment is 55.65【1.00% (95% CI, 53.70-57.61). Conclusion: We found evidence to support the efficacy of topical immunotherapy with DPCP in AA. However, for an unbiased estimate of the effect of treatment, better designed RCTs are needed that have a clinically relevant endpoint (e.g., long-term overall regrowth) in a well-selected population.