Current Insights Into The Management Of Discoid Lupus Erythematosus

Figures & data

Table 2 Strength Of Recommendation (NICE, National Institute For Health And Clinical Excellence; RCT, Randomised Controlled Trial)

Class	Evidence
A	At least one meta-analysis, systematic review or RCT rated as 1++, and directly applicable to the target of population, or A systematic review of RCTs or a body of evidence consisting principally of studies rated as 1+, directly applicable to the target of population and demonstrating overall consistency of results Evidence drawn from a NICE technology appraisal
B	A body of evidence including studies rated as 2++, directly applicable to the target of population and demonstrating overall consistency of results, or Extrapolated evidence from studies rated as 1++ or 1+
C	A body of evidence including studies rated as 2+, directly applicable to the target of population and demonstrating overall consistency of results, or Extrapolated evidence from studies rated as 2++
D	Evidence level 3 or 4, or Extrapolated evidence from studies rated as 2+, or Formal consensus
D (GPP)	A good practice point (GPP) is a recommendation for best practice based on the experience of the guideline development group

Table 1 Strength Of Recommendation And Level Of Evidence

Treatment	Strength Of Recommendation	Level Of Evidence
Lifestyles measures
Photoprotection	A	1++
Smoking cessation	A	1++
Topical treatment
Topical and intralesional corticoesteroids	A	1+
Topical calcineurin inhibitors	A	1+
Topical retinoids	D	3
Tocoretinate	D	3
R-salbutamol	D	1-
Systemic therapies
Antimalarials	B	2++
Azathioprine	D	3
Systemic retinoids	C	2+
Methotrexate	C	2+
Fumaric acid esters	C	2+
Mycophenolate mofetil	D	3
Thalidomide, Lenalidomide	C	2+
Systemic corticosteroids	D	3
Clofazimine	C	1+
Biological therapies
Apremilast	D	3
Ustekinumab	D	3
Anti-JAK	D	3
Alternative therapies
Laser	C	2+
Photodynamic therapy	D	3
Intravenous Immunoglobulin	D	3

Table 3 Level Of Evidence (RCT, Randomized Controlled Trial; A. Studies With A Level Of Evidence “-” Should Not Be Used As A Basis For Making A Recommendation)

Level Of Evidence	Type Of Evidence
1++	High-quality meta-analyses, systematic reviews of RCTs, or RCT with a very low risk of bias
1+	Well-conducted meta-analyses, systematic reviews of RCTs, or RCT with a very low risk of bias
1-	Meta-analyses, systematic reviews of RCTs, or RCT with a high low risk of bias^A
2++	High-quality systematic reviews of case-control or cohort studies
	High-quality case-control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal
2+	Well-conducted case-control or cohort studies with a low risk of confounding, bias or chance and a moderate probability that the relationship is causal
2-	Case-control or cohort studies with a high risk of confounding, bias or chance and a significant risk that the relationship is not causal^A
3	Non-analytical studies (for example, case reports, case series)
4	Expert opinion, formal consensus

Table 4 Proposal Of Treatment Algorithm. Combination Between Medical (topical, Systemic Or Both) And Physical (laser, Photodynamic Therapy) Therapies In Refractory Lesions Should Be Considered

Proposal of Treatment
Lifestyles measures
Mandatory	Photoprotection
	Smoking cessation
First-line therapies
	Topical and intralesional corticosteroids
	Topical calcineurin inhibitors
Second-line therapies
	1º Hydroxychloroquine
	2º Chloroquine
	Switching between them
Third-line therapies
	Methotrexate
	Systemic retinoids
	Fumaric acid esters
	Thalidomide, lenalinomide
	Clofazimine
	Laser
	Ustekinumab
	Others: azathioprine, mycophenolate mofetil, systemic corticosteroids, apremilast, photodynamic therapy, intravenous immunoglobulin
Experimental therapies
	Dapsone
	Rituximab
	Anti-IL-6 antibodies
	Anti-JAK