Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials

黄褐斑治疗疗效比较：随机对照试验的Meta分析

Background: Melasma is an acquired pigmentation disorder with challenges in treatment because of its refractory nature and high risk of recurrence. Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analysis (NMA). Methods: The PubMed, Embase, and Cochrane Library databases were searched till December 2020 using the melasma area and severity index as a therapeutic index. A total of 59 randomized controlled trials (RCTs) met the inclusion criteria and were selected. Results: The ranking of relative efficacy compared with placebo in descending order was Q-switched Nd:Yag 1,064-nm laser (QSND), intense pulsed light, ablative fractional laser (AFL), triple combined cream (TCC), topical vitamin C, oral tranexamic acid (oTA), peeling, azelaic acid, microneedles (MNs), topical tranexamic acid (tTA), tretinoin, picosecond laser, hydroquinone (HQ), and non-AFL. Moreover, QSND was more effective than HQ and tTA against melasma. The ranking of percentage (%) of side effects in ascending order for each of 14 therapies with more than 80 participants was tretinoin (10.1%), oTA (17.6%), HQ (18.2%), AFL (20.0%), QSND (21.5%), TCC (25.7%), tTA (36.75%), peeling (38.0%), and MN (52.3%). Taking both efficacy and safety into consideration, TCC was found to be the most favorable selection among the topical drugs for melasma. QSND and AFL were still the best ways to treat melasma among photoelectric devices. oTA as system administration was a promising way recommended for melasma. Among 31 studies, 87% (27/31) studies showed that the efficacy of combination therapies is superior to that of single therapy. The quality of evidence in this study was generally high because of nearly 50% of split-face RCTs. Conclusions: Based on the published studies, this NMA indicated that QSND, AFL, TCC, and oTA would be the preferred ways to treat melasma for dermatologists. However, more attention should be paid to the efficacy and safety simultaneously during the clinical application. Most of the results were in line with those of the previous studies, but a large number of RCTs should be included for validation or update. Systematic Review Registration: identifier: CRD42021239203.

背景：黄褐斑是一种获得性色素沉着障碍，由于其难治性和高复发风险，治疗具有挑战性。目的：本研究旨在采用系统评价和网络Meta分析（NMA）比较14种常用黄褐斑治疗的疗效和副作用。方法：检索PubMed、Embase和Cochrane Library数据库截至2020年12月的文献，以黄褐斑面积和严重程度指数作为疗效指标。共59项符合纳入标准的随机对照试验（RCT）被纳入。结果：与安慰剂相比，相对疗效由高到低排序依次为：Q开关Nd:YAG 1,064 nm激光（QSND）、强脉冲光、剥脱性点阵激光（AFL）、三联乳膏（TCC）、外用维生素C、口服氨甲环酸（oTA）、化学剥脱、壬二酸、微针（MNs）、外用氨甲环酸（tTA）、维A酸、皮秒激光、氢醌（HQ）和非剥脱性点阵激光。此外，QSND对黄褐斑的疗效优于HQ和tTA。在参与者超过80例的14种疗法中，副作用百分比（%）由低到高排序为：维A酸（10.1%）、oTA（17.6%）、HQ（18.2%）、AFL（20.0%）、QSND（21.5%）、TCC（25.7%）、tTA（36.75%）、化学剥脱（38.0%）和微针（52.3%）。综合考虑疗效和安全性，TCC被认为是外用药物治疗黄褐斑中最有利的选择。在光电设备中，QSND和AFL仍是治疗黄褐斑的最佳方式。oTA作为系统给药是推荐用于黄褐斑的一种有前景的方式。在31项研究中，87%（27/31）的研究显示联合治疗的疗效优于单一治疗。本研究的证据质量总体较高，因为近50%为面部左右对照RCT。结论：基于已发表的研究，本NMA表明QSND、AFL、TCC和oTA将是皮肤科医生治疗黄褐斑的首选方式。然而，在临床应用中应同时关注疗效和安全性。大多数结果与既往研究一致，但仍需纳入大量RCT进行验证或更新。注册号：CRD42021239203。

Liu Y, Wu S, Wu H, Liang X, Guo D, Zhuo F. Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne). 2021 Sep 29;8:713554.

20210929-黄褐斑治疗比较 随机对照试验的荟萃分析.pdf