Dang Yu-Ping, Li Qiang, Shi Fei, Yuan Xiao-Ying, Liu Wei
Department of Dermatology, Air Force General Hospital of People's Liberation Army, Beijing, China.
Dermatol Ther. 2016 Mar-Apr;29(2):126-33. doi: 10.1111/dth.12295. Epub 2015 Oct 13.
Vitiligo is a common skin disease for which immunomodulating calcineurin inhibitors have been considered reasonable treatment. We searched the MEDLINE, Embase, and Cochrane central register of controlled trials databases for articles published prior to September 2014. Thirteen studies were included in the meta-analysis. After pooling the trials, we concluded that calcineurin inhibitors showed a better therapeutic effect on vitiligo than placebo, according to lesion report (RR = 2.62, 95%CI, 1.39-4.93, p = 0.003) and patient report (RR = 1.42, 95%, 0.87-2.31, p = 0.157). Subgroup analysis was performed to determine whether the combination with phototherapy was a source of heterogeneity. The trial sequence analysis indicated that the results of combined therapy by lesion report were reliable and conclusive. However, in the patient report trials, the frequency of lesions on the hand and foot was higher, and the effect of combined therapy was still not significant. Calcineurin inhibitors showed a better therapeutic effect than placebo in the treatment of vitiligo with phototherapy. However, the typical UV-resistant sites (i.e., hand and foot) were still difficult to cure even with combined therapy. Because of concerns about photocarcinogenesis, the clinical application of combined therapy should be explored with caution.
白癜风是一种常见的皮肤病，免疫调节性钙调神经磷酸酶抑制剂被认为是合理的治疗方法。我们在MEDLINE、Embase和Cochrane对照试验中央注册数据库中检索了2014年9月之前发表的文章。13项研究被纳入荟萃分析。汇总试验后，我们得出结论，根据皮损报告（RR = 2.62，95%CI，1.39 - 4.93，p = 0.003）和患者报告（RR = 1.42，95%，0.87 - 2.31，p = 0.157），钙调神经磷酸酶抑制剂对白癜风的治疗效果优于安慰剂。进行亚组分析以确定与光疗联合是否是异质性的来源。试验序贯分析表明，根据皮损报告的联合治疗结果可靠且具有决定性。然而，在患者报告的试验中，手足部位的皮损频率较高，联合治疗的效果仍然不显著。钙调神经磷酸酶抑制剂在光疗治疗白癜风方面比安慰剂显示出更好的治疗效果。然而，即使采用联合治疗，典型的抗紫外线部位（即手足）仍然难以治愈。由于担心光致癌作用，联合治疗的临床应用应谨慎探索。
