Department of Dermatology, The Third Xiangya Hospital/Central South University, Changsha, Hunan, China.
J Cutan Med Surg. 2024 Nov-Dec;28(6):536-542. doi: 10.1177/12034754241266177. Epub 2024 Aug 5.
Photodynamic therapy (PDT) is an effective treatment for actinic keratosis (AK) and uses different light sources as well as photosensitizers. In addition, PDT is often combined with other physical therapies or drugs.
This study was aimed to compare the efficacy of different PDTs against AK lesions based on Complete Response (CR) by conducting a network meta-analysis (NMA).
Randomized controlled trials (RCTs) using PDT for AK were screened and a Bayesian model was developed to perform an NMA of CR at 3 months after the first treatment.
Twenty-six trials involving 2285 patients and 14 treatments were included. The treatments were broadly divided into mono-PDT and combination therapy. The photodynamic monotherapies included methyl 5-aminolevulinic acid (MAL)-daylight (DL)-PDT, MAL-light-emitting diode (LED)-PDT, 5-aminolevulinic acid (ALA)-LED-PDT, etc. Combination therapies included ablative fractional laser (AFL)-assisted MAL-LED-PDT, calcipotriol (CAL)-assisted MAL-LED-PDT, and 5-fluorouracil (5-Fu)-assisted MAL-DL-PDT. The results of the NMA showed that there is a high probability that AFL-MAL-LED-PDT is the most effective treatment option, followed by CAL-MAL-LED-PDT and ALA-LED-PDT. The subgroup analysis showed that MAL-based PDT had better efficacy when using LED versus other light sources, while LED-based PDT was likely to have better efficacy when using ALA versus other photosensitizers.
The results of this NMA suggest that AFL-MAL-LED-PDT may be the superior choice for achieving complete clearance of AK lesions. PDT using LED as the light source and ALA as the photosensitizer may be more effective for the treatment of AK. However, more RCTs are needed to verify the results of this analysis.
光动力疗法（PDT）是一种有效的治疗光化性角化病（AK）的方法，它使用不同的光源和光敏剂。此外，PDT 通常与其他物理疗法或药物联合使用。
本研究旨在通过网络荟萃分析（NMA）比较不同 PDT 治疗 AK 病变的疗效，以完全缓解（CR）为标准。
筛选了使用 PDT 治疗 AK 的随机对照试验（RCT），并建立了贝叶斯模型，对首次治疗后 3 个月的 CR 进行 NMA。
纳入了 26 项 RCT，涉及 2285 名患者和 14 种治疗方法。这些治疗方法大致可分为单 PDT 和联合治疗。光动力单药治疗包括 5-氨基酮戊酸（MAL）-日光（DL）-PDT、MAL-发光二极管（LED）-PDT、5-氨基酮戊酸（ALA）-LED-PDT 等。联合治疗包括消融性点阵激光（AFL）辅助 MAL-LED-PDT、卡泊三醇（CAL）辅助 MAL-LED-PDT、5-氟尿嘧啶（5-Fu）辅助 MAL-DL-PDT 等。NMA 的结果表明，AFL-MAL-LED-PDT 是最有效的治疗方法的可能性非常高，其次是 CAL-MAL-LED-PDT 和 ALA-LED-PDT。亚组分析表明，使用 LED 作为光源时，基于 MAL 的 PDT 疗效更好，而使用 ALA 作为光敏剂时，基于 LED 的 PDT 可能更有效。
这项 NMA 的结果表明，AFL-MAL-LED-PDT 可能是治疗 AK 病变获得完全清除的首选方法。使用 LED 作为光源和 ALA 作为光敏剂的 PDT 可能更有效治疗 AK。然而，需要更多的 RCT 来验证本分析的结果。
