AI Center.
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan.
Ann Plast Surg. 2024 Jan 1;92(1S Suppl 1):S52-S59. doi: 10.1097/SAP.0000000000003759.
Keloids are common benign skin lesions originating from a disorganized fibroproliferative collagen response; these lesions often lead to both physical and psychological problems. The optimal treatment for keloids is yet to be standardized. Intralesional injection, which is simple and nontraumatic, is one of the most commonly used treatment modalities for these lesions. In this study, we compared 5 different drugs (intralesional injections) for the treatment of keloids in terms of efficacy.
We systemically searched relevant studies on PubMed, EMBASE, and Cochrane Library. Randomized clinical trials on the safety and efficacy of triamcinolone acetonide (TAC), 5-fluorouracil (5-FU), botulinum toxin A (BTA), verapamil, and bleomycin were included in this study.
This network meta-analysis included a total of 1114 patients from 20 randomized controlled trials. Botulinum toxin A alone and TAC plus 5-FU exhibited significantly better efficacy than did 5-FU, TAC, and verapamil. No significant difference in efficacy between BTA alone and TAC combined with 5-FU was observed. No significant differences were noted in the adverse event rate between BTA, TAC plus 5-FU, 5-FU, and TAC. Furthermore, we performed surface under the cumulative ranking curve analyses to predict the rank of each intervention (by efficacy and adverse event rate). The predicted ranking by efficacy was as follows: TAC plus 5-FU, BTA, bleomycin, TAC, 5-FU, and verapamil; the predicted ranking by adverse events was as follows: TAC, 5-FU, TAC plus 5-FU, and BTA. Funnel plot analysis revealed no publication bias.
Botulinum toxin A and TAC plus 5-FU appear to have outstanding therapeutic efficacy for keloids. The rate of adverse events was similar among BTA, TAC, 5-FU, and TAC plus 5-FU. Nonetheless, additional reviews of rigorous, large-scale randomized controlled trials are warranted for further validation of our findings.
瘢痕疙瘩是一种常见的良性皮肤病变，源于纤维组织增生性胶原反应紊乱；这些病变常导致身体和心理问题。瘢痕疙瘩的最佳治疗方法尚未标准化。局部注射，简单且无创，是治疗这些病变最常用的方法之一。在这项研究中，我们比较了 5 种不同药物（局部注射）治疗瘢痕疙瘩的疗效。
我们系统地在 PubMed、EMBASE 和 Cochrane Library 上搜索了相关研究。纳入了关于曲安奈德（TAC）、5-氟尿嘧啶（5-FU）、肉毒毒素 A（BTA）、维拉帕米和博来霉素治疗安全性和疗效的随机临床试验。
这项网络荟萃分析共纳入了 20 项随机对照试验的 1114 名患者。肉毒毒素 A 单独使用和 TAC 联合 5-FU 的疗效明显优于 5-FU、TAC 和维拉帕米。BTA 单独使用与 TAC 联合 5-FU 的疗效无显著差异。BTA、TAC 联合 5-FU、5-FU 和 TAC 的不良反应发生率无显著差异。此外，我们进行了累积排序曲线下面积分析，以预测每种干预措施的排名（按疗效和不良反应发生率）。按疗效预测的排名如下：TAC 联合 5-FU、BTA、平阳霉素、TAC、5-FU 和维拉帕米；按不良反应预测的排名如下：TAC、5-FU、TAC 联合 5-FU 和 BTA。漏斗图分析未发现发表偏倚。
肉毒毒素 A 和 TAC 联合 5-FU 似乎对瘢痕疙瘩有显著的治疗效果。BTA、TAC、5-FU 和 TAC 联合 5-FU 的不良反应发生率相似。然而，需要进一步的严格、大规模随机对照试验来进一步验证我们的研究结果。
