Comparison of various excimer laser (EL) combination therapies for vitiligo: a systematic review and network meta-analysis

Figures & data

Figure 1. Search flowchart.

Table 1. Characteristics of studies.

Study (year), Country	Blinded design	Treatment duration	Intervention		EL treatment site	Sample size (n)		Age, mean (SD), years		Gender (M/F) (n)		Follow-up	Repigmentation
			T	C		T	C	T	C	T	C	time	rate
Elsaadany et al. (29) (2022), Egypt	NB	≥4 months	EL + PRP	EL	Head, neck, trunk, limbs	36	36	20.47 ± 9.07	20.47 ± 9.07	5/31	5/31	3 months	≥75% and ≤25%
Juntongjin et al. (31) (2021), Thailand	DB	3 months	EL + calcipotriol	EL + clobetasol	Double upper limbs	13	13	53.15 ± 19.02	53.15 ± 19.02	7/6	7/6	3 months	≥75% and ≤25%
Khattab et al. (30) (2020), Egypt	SB	4 months	EL + PRP	EL	Face, trunk, limbs	26	26	25.42 ± 7.60	24.9 ± 5.60	4/22	6/20	3 months	≥75% and ≤25%
Juntongjin et al. (21) (2020), Thailand	DB	3 months	EL + MF	EL	Face	8	8	46.5 ± 16.42	46.5 ± 16.42	5/3	5/3	3 months	≥75% and ≤25%
Deng et al. (23) (2020), China	NB	3 months	EL + PRP	EL	NR	20	20	39.65± 11.49	42.20± 12.35	9/11	7/13	3 months	≥75% and ≤25%
Soliman et al. (20) (2016), Egypt	NB	3 months	EL + antioxidants	EL	Face, neck, trunk, limbs	45	45	NR	NR	NR	NR	3 months	≥75% and ≤25%
Ghalamkarpour et al. (33) (2011), Iran	NB	4 months	EL + calcipotriol	EL	Face, neck, trunk, limbs	14	14	33.1± 8.7	37.7± 12.6	8/6	6/8	4 months	≥75% and ≤25%
Sassi et al. (34) (2008). Italy	NB	3 months	EL + HB	EL	Face, neck	42	42	42.4± 11.67	44.1± 13.61	20/22	20/22	4 months	≥75%
Lu-Yan et al. (32) (2006), China	SB	3 months	EL + tacalcitol	EL	Face, neck, trunk, limbs	35	35	34.8± 16	34.8 ± 16	19/16	19/16	3 months	≥75% and ≤25%
Passeron et al. (35) (2004), France	NB	3 months	EL + tacrolimus	EL	Face, neck, trunk, limbs	23	20	NR	NR	NR	NR	3 months	≥75% and ≤25%
Kawalek et al. (36) (2004), America	DB	10 weeks	EL + tacrolimus	EL	Face, trunk, limbs	10	10	NR	NR	NR	NR	6 months	≥75% and ≤25%

Note: DB: double-blind; SB: single-blind; NB: nonblind; T: treatment; C: control; NR: not report; EL: excimer laser; PRP: platelet-rich plasma; MF: mometasone furoate; HB: hydrocortisone 17-butyrate cream.

Figure 2. Risk of bias graph.

Figure 3. Risk of bias summary.

Figure 4. Network diagram for the repigmentation rate ≥ 75%. EL: excimer laser; HB: hydrocortisone 17-butyrate cream; MF: mometasone furoate; PRP: platelet-rich plasma.

Figure 5. Network diagram for the repigmentation rate ≤ 25%. EL: excimer laser; MF: mometasone furoate; PRP: platelet-rich plasma.

Table 2. Network meta-analysis of the repigmentation rate (≥75%).

EL + TRL
0.61 (0.01, 67.49)	EL + TAC
0.76 (0.01, 16.6)	1.23 (0.01, 78.45)	EL + PRP
1.49 (0.01, 159.37)	2.44 (0.01, 587.82)	1.99 (0.03, 277.86)	EL + MF
1.25 (0.01, 115.17)	2.06 (0.01, 433.33)	1.62 (0.03, 200.14)	0.84 (0, 178.3)	EL + HB
58811944510519.9 (0.67, 5.57572754430175e + 44)	105816005117685 (0.95, 9.19817600007448e + 44)	88314522535155.5 (1.07, 9.06479759418698e + 44)	41616034774082.7 (0.37, 4.31878581896898e + 44)	46758716793242 (0.46, 4.6995124605838e + 44)	EL + CLO
0.57 (0, 79.31)	0.93 (0, 276.92)	0.79 (0.01, 135.58)	0.38 (0, 115.51)	0.46 (0, 112.34)	0 (0, 0.37)	EL + CAL
0 (0, 0.28)	0 (0, 0.63)	0 (0, 0.42)	0 (0, 0.27)	0 (0, 0.26)	0 (0, 0)	0 (0, 0.84)	EL + AO
3.32 (0.23, 49.64)	5.46 (0.12, 283.27)	4.45 (0.68, 76.08)	2.21 (0.05, 116.16)	2.68 (0.07, 100.82)	0 (0, 4.26)	5.79 (0.1, 543.85)	176871883.21 (15.41, 1.58707326992159e + 27)	EL

Note: EL: excimer laser; AO: antioxidant; CAL: calcipotriol; CLO: clobetasol; HB: hydrocortisone 17-butyrate cream; MF: mometasone furoate; TAC: tacalcitol; TRL: tacrolimus; PRP: platelet-rich plasma.

Figure 6. Surfaces under the cumulative ranking curve (SUCRA) probability line chart for the repigmentation rate ≥ 75%. EL: excimer laser; HB: hydrocortisone 17-butyrate cream; MF: mometasone furoate; PRP: platelet-rich plasma.

Table 3. Surfaces under the cumulative ranking curve ranking for repigmentation rates (≥75% and ≤25%).

Intervention	≥75%	≤25%
EL + antioxidants	98.8%	57.2%
EL + calcipotriol	59.8%	41.3%
EL + tacalcitol	59.6%	61.7%
EL + platelet-rich plasma	58.8%	44.5%
EL + tacrolimus	52.4%	28.6%
EL + hydrocortisone 17-butyrate cream	47.9%
EL + mometasone furoate	45.0%	46.5%
EL	25.3%	77.6%
EL + clobetasol	2.5%	42.7%

Note: EL: excimer laser.

Table 4. Network meta-analysis of the repigmentation rate (≤25%).

EL + TRL
0.32 (0.01, 9.9)	EL + TAC
0.56 (0.03, 8.23)	1.74 (0.07, 43.85)	EL + PRP
0.56 (0.01, 57.09)	1.78 (0.02, 236.27)	1.03 (0.02, 90.7)	EL + MF
0.66 (0.01, 59.75)	2.04 (0.02, 256)	1.18 (0.02, 94.29)	1.14 (0, 226.25)	EL + CLO
0.66 (0.02, 24.34)	2.05 (0.04, 115.24)	1.18 (0.04, 37.15)	1.15 (0.01, 114.5)	1 (0.07, 14.85)	EL + CAL
0.38 (0.01, 11.49)	1.17 (0.02, 55.25)	0.67 (0.03, 17.38)	0.66 (0, 54.32)	0.57 (0, 67.86)	0.57 (0.01, 29.25)	EL + AO
0.23 (0.02, 1.83)	0.71 (0.04, 10.93)	0.41 (0.07, 2.37)	0.4 (0.01, 13.15)	0.34 (0.01, 17.1)	0.34 (0.02, 5.95)	0.6 (0.04, 9.37)	EL

Note: EL: excimer laser; AO: antioxidant; CAL: calcipotriol; CLO: clobetasol; MF: mometasone furoate; TAC: tacalcitol; TRL: tacrolimus; PRP: platelet-rich plasma.

Figure 7. Surfaces under the cumulative ranking curve (SUCRA) probability line chart for the repigmentation rate ≤ 25%. EL: excimer laser; MF: mometasone furoate; PRP: platelet-rich plasma.

Table 5. Adverse events reported in included studies.

	Erythema	Burning sensation	Hyperpigmentation	Pain	Photosensitivity	Vesicles	Bullae
EL + PRP	13/82(15.9%)	8/82(9.8%)	19/82(23.2%)	6/82(7.3%)	–	–	–
EL	81/256(31.6%)	7/256(2.7%)	21/256(8.2%)	–	1/256(0.4%)	1/256(0.4%)	2/256 (0.8%)
EL + CAL	2/27(7.4%)	–	–	–	–	–	–
EL + HB	22/42(52.4%)	–	5/42(11.9%)	–	–	–	–
EL + TRL	33/33(100%)	–	–	5/33(15.2%)	–	–	2/33 (6.1%)

Note: EL: excimer laser; CAL: calcipotriol; HB: hydrocortisone 17-butyrate cream; TRL: tacrolimus; PRP: platelet-rich plasma.

Figure 8. Funnel plot for the repigmentation rate ≥ 75%. EL: excimer laser; AO: antioxidant; CAL: calcipotriol; CLO: clobetasol; HB: hydrocortisone 17-butyrate cream; MF: mometasone furoate; TAC: tacalcitol; TRL: tacrolimus; PRP: platelet-rich plasma.

Figure 9. Funnel plot for the repigmentation rate ≤ 25%. EL: Excimer laser; AO: antioxidant; CAL: calcipotriol; CLO: clobetasol; MF: mometasone furoate; TAC: tacalcitol; TRL: tacrolimus; PRP: platelet-rich plasma.

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Data availability statement

The data of this study are available from the corresponding author upon reasonable request.