Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.
Gene Expression and Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania, USA.
Dermatol Ther. 2021 May;34(3):e14916. doi: 10.1111/dth.14916. Epub 2021 Mar 4.
Existing guidelines form no consensus for alopecia areata (AA) treatment due to the absence of a universal standard treatment and arbitrary selection of reference arms in randomized control trials (RCTs). The aim is to identify the best treatment and to rank treatments using systematic review and network meta-analysis. Data were extracted by the two investigators independently. Odds ratio (OR) of treatment success rate was pooled using the frequentist weighted least squares approach to random-model network meta-analysis. RCTs providing data of treatment success rate from PubMed, EMBASE, Web of Science, and manual search were included. About 54 RCTs consisting of 49 treatments and 3149 patients were included. Pentoxifylline plus topical corticosteroids had the highest treatment success rate compared with "no treatment," followed by pentoxifylline alone, topical calcipotriol plus narrowband ultraviolet radiation B phototherapy, topical calcipotriol, intralesional corticosteroids, systemic corticosteroids, minoxidil plus topical corticosteroids, topical bimatoprost, psoralen ultraviolet radiation A phototherapy, and tofacitinib. Even with the network meta-analysis, the best treatment because of independent loops and wide confidence intervals could not be identified. Treatment options above may be reasonable strategies, but further comparison is required.
由于缺乏普遍标准的治疗方法和随机对照试验 (RCT) 中参考臂的任意选择，现有的斑秃治疗指南尚未达成共识。本研究旨在通过系统评价和网络荟萃分析来确定最佳治疗方法并对治疗方法进行排序。数据由两位研究者独立提取。采用固定效应模型的网络荟萃分析，使用频率论加权最小二乘法对治疗成功率的比值比 (OR) 进行汇总。纳入了来自 PubMed、EMBASE、Web of Science 和手动检索的提供治疗成功率数据的 RCT。共纳入了 54 项 RCT，包含 49 种治疗方法和 3149 名患者。与“不治疗”相比，联合应用己酮可可碱和局部皮质类固醇的治疗成功率最高，其次是单独应用己酮可可碱、局部卡泊三醇加窄谱中波紫外线光疗、局部卡泊三醇、皮损内皮质类固醇、全身皮质类固醇、米诺地尔加局部皮质类固醇、局部比马前列素、补骨脂素加紫外线 A 光疗和托法替尼。即使进行了网络荟萃分析，由于独立的循环和置信区间较宽，也无法确定最佳治疗方法。上述治疗选择可能是合理的策略，但需要进一步比较。
