The limitations of systematic reviews

The large number of clinical studies in dermatology and the lack of consensus on the management of many skin disorders point to systematic reviews as a way to improve the evidence and to guide clinical decisions. However, systematic reviews alone cannot be expected to overcome the methodological limitations in dermatological research we have noted. On the contrary, there are some indications that systematic reviews, if not properly guided by important clinical questions, might amplify the unimportant issues and may result in a rather misleading scale of evidence to guide clinical decisions. Since most randomised clinical trials are sponsored by pharmaceutical companies, it is quite plausible that data-driven systematic reviews will reflect the priorities as perceived by pharmaceutical companies and not necessarily by the public and clinicians. On the other hand, without a change in regulatory procedures, pharmaceutical companies will continue to pay little attention to comparative RCTs and will continue to assess drugs for indications that are worth the financial investment, neglecting rare but clinically important disorders.

Systematic reviews alone cannot fill the gap and we urgently need fresh primary research and high-quality and relevant clinical trials.29

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