■光动力疗法(PDT)是光化性角化病(AK)的有效治疗方法,并使用不同的光源以及光敏剂。此外,PDT通常与其他物理治疗或药物组合。
■本研究旨在通过进行网络荟萃分析(NMA),比较基于完全反应(CR)的不同PDT对AK病变的疗效。
■筛选了使用PDT进行AK的随机对照试验(RCT),并开发了贝叶斯模型以在首次治疗后3个月进行CR的NMA。
■纳入了26项试验,涉及2285名患者和14种治疗方法。治疗大致分为单PDT和联合治疗。光动力单一疗法包括甲基5-氨基乙酰丙酸(MAL)-日光(DL)-PDT,MAL-发光二极管(LED)-PDT,5-氨基乙酰丙酸(ALA)-LED-PDT,等。联合治疗包括消融点阵激光(AFL)辅助MAL-LED-PDT,卡泊三醇(CAL)辅助MAL-LED-PDT,和5-氟尿嘧啶(5-Fu)辅助的MAL-DL-PDT。NMA的结果表明,AFL-MAL-LED-PDT很有可能是最有效的治疗选择,其次是CAL-MAL-LED-PDT和ALA-LED-PDT。亚组分析显示,基于MAL的PDT在使用LED时优于其他光源,而与其他光敏剂相比,使用ALA时,基于LED的PDT可能具有更好的疗效。
■此NMA的结果表明,AFL-MAL-LED-PDT可能是实现AK病变完全清除的较优选择。使用LED作为光源和ALA作为光敏剂的PDT对于AK的治疗可能更有效。然而,需要更多的随机对照试验来验证本分析的结果.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.