Self-guided vs. Therapist-guided CBT for AD
Trial question
Is self-guided CBT noninferior to clinician-guided CBT in patients with atopic dermatitis?
Study design
Single center
Single blinded
RCT
Population
Characteristics of study participants
85.0% female
15.0% male
N = 168
168 patients (142 female, 26 male).
Inclusion criteria: adult patients with atopic dermatitis.
Key exclusion criteria: other disease or condition that has immediate treatment priority over atopic dermatitis.
Interventions
N=86 self-guided CBT (brief digital intervention based on CBT without clinician support for 12 weeks).
N=82 clinician-guided CBT (clinician-guided comprehensive digital intervention based on CBT for 12 weeks).
Primary outcome
Improvement in self-reported Patient-Oriented Eczema Measure score at week 12
4.6 points
4.2 points
4.6 points
3.4 points
2.3 points
1.1 points
0.0 points
Self-guided
CBT
Clinician-guided
CBT
Difference not exceeding
non-inferiority
margin ✓
Difference not exceeding non-inferiority margin in improvement in self-reported Patient-Oriented Eczema Measure score at week 12 (4.6 points vs. 4.2 points; MD 0.36, 97.5% CI -Infinity to 1.75).
Secondary outcomes
No significant difference in mean Dermatological Life Quality Index at 6 month follow-up (6.2 points vs. 6.75 points; MD -0.74, 95% CI -3.3 to 2.2).
No significant difference in mean Insomnia Severity Index at 6 months (7.26 points vs. 9.46 points; MD -0.28, 95% CI -4.75 to 0.35).
No significant difference in mean peak pruritus numerical rating scale at 6 months (3.78 points vs. 4.22 points; MD -0.02, 95% CI -1.4 to 0.52).
Conclusion
In adult patients with atopic dermatitis, self-guided CBT was noninferior to clinician-guided CBT with respect to improvement in self-reported Patient-Oriented Eczema Measure score at week 12.
Reference
Dorian Kern, Brjánn Ljótsson, Louise Lönndahl et al. Self-Guided vs Clinician-Guided Online Cognitive Behavioral Therapy for Atopic Dermatitis: A Randomized Clinical Trial. JAMA Dermatol. 2024 Dec 18. Online ahead of print.
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