Yuanyuan Wan, Qinghai Zeng, Ling Jiang, Chuhan Fu, Shunmin Mao, Lan Zhang, Yushan Zhang, Xiaolin Zhang, Lu Zhu, Fan Zhang, Jing Chen, Li Lei
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引用次数: 0
Abstract
Background: 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.
Objectives: 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).
Methods: 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.
Results: 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.
Conclusions: 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.
背景：光动力疗法（PDT）是治疗光化性角化病（AK）的一种有效方法，它使用不同的光源和光敏剂。此外，光动力疗法还经常与其他物理疗法或药物结合使用：本研究旨在通过进行网络荟萃分析（NMA），以完全应答（CR）为基础，比较不同PDT对AK病变的疗效：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进行网络荟萃分析：结果：共纳入 26 项试验，涉及 2285 名患者和 14 种治疗方法。这些疗法大致分为单一光动力疗法和联合疗法。光动力单一疗法包括5-氨基乙酰丙酸甲酯（MAL）-日光（DL）-PDT、MAL-发光二极管（LED）-PDT、5-氨基乙酰丙酸（ALA）-LED-PDT等。联合疗法包括消融点阵激光（AFL）辅助 MAL-LED-PDT、钙泊三醇（CAL）辅助 MAL-LED-PDT、5-氟尿嘧啶（5-Fu）辅助 MAL-DL-PDT。NMA结果显示，AFL-MAL-LED-PDT极有可能是最有效的治疗方案，其次是CAL-MAL-LED-PDT和ALA-LED-PDT。亚组分析表明，使用 LED 与其他光源相比，基于 MAL 的 PDT 疗效更好，而使用 ALA 与其他光敏剂相比，基于 LED 的 PDT 疗效可能更好：本 NMA 的结果表明，AFL-MAL-LED-PDT 可能是彻底清除 AK 病变的最佳选择。使用 LED 作为光源、ALA 作为光敏剂的 PDT 治疗 AK 可能更有效。不过，还需要更多的临床试验来验证这一分析结果。
期刊介绍：
Journal of Cutaneous Medicine and Surgery (JCMS) aims to reflect the state of the art in cutaneous biology and dermatology by providing original scientific writings, as well as a complete critical review of the dermatology literature for clinicians, trainees, and academicians. JCMS endeavours to bring readers cutting edge dermatologic information in two distinct formats. Part of each issue features scholarly research and articles on issues of basic and applied science, insightful case reports, comprehensive continuing medical education, and in depth reviews, all of which provide theoretical framework for practitioners to make sound practical decisions. The evolving field of dermatology is highlighted through these articles. In addition, part of each issue is dedicated to making the most important developments in dermatology easily accessible to the clinician by presenting well-chosen, well-written, and highly organized information in a format that is interesting, clearly presented, and useful to patient care.
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