喜安 楊

  • Comparative Efficacy of Different Drugs for the Treatment of Keloids: A Network Meta-Analysis

    Objectives
    Keloids are common benign skin lesions emanating from a disorganized fibroproliferative collagen response, which often result in both physical and psychological problems. Currently, the optimal treatment for keloids remains controversial and lacks uniform standard. Among these treatment options, drug injection is commonly used in clinics due to simple operation and less trauma. Therefore, the aim of this study is to compare the clinical effectiveness of intralesional injection of five different drugs for the treatment of keloids.

    Methods
    We systemically searched relevant studies on PubMed, EMBASE, and Cochrane Library. Randomized clinical trials evaluating different treatment strategies
    of keloids, including triamcinolone acetonide (TAC), 5-fluorouracil (5-FU), botulinum toxin A (BTA), verapamil and bleomycin were
    included in the study.

    Results
    The network meta-analysis included a total of 994 patients from nineteen randomized controlled trials. According to the result of network meta-analysis, we found that both BTA and TAC plus 5-FU showed significantly better efficacy than 5-FU, TAC and verapamil. There was no significant difference between BTA and TAC plus 5-FU. As to the adverse event rate, the result of network meta-analysis demonstrated that there was no statistically significant difference between BTA, TAC plus 5-FU, 5-FU and TAC. Furthermore, the surface under the cumulative ranking (SUCRA) curve was utilized to predict the order of efficacy and adverse event rate. The order of efficacy was predicted as follows: BTA> TAC combined with 5-FU> Bleomycin> 5-FU> TAC> verapamil, and the order of adverse event rate was predicted as follows: TAC> 5-FU> TAC combined with 5-FU> BTA. No publication bias was found based on the funnel plot.

    Conclusion
    In terms of the intralesional injection therapy for keloids, the study recommends BTA and TAC plus 5-FU, both of which demonstrate outstanding therapeutic efficacy for keloids without significantly different adverse event rate. However, additional reviews of rigorous, large-scale RCTs are required for further verification.

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