Relative impact of monotherapies for vitiligo: A network meta-analysis study

Abstract

Vitiligo, a stigmatizing condition characterized by patchy depigmented skin, has an estimated global prevalence of 0.36%. This condition is a risk factor for anxiety, depression, and even suicidal ideation. Hitherto, no network meta-analysis has investigated the relative effect of vitiligo on relevant monotherapies. The current study determined the relative effect of monotherapies for vitiligo through network meta-analyses (NMAs). The peer-reviewed literature was systematically searched through PubMed and Scopus; studies that were eligible for quantitative analyses were those that were published in English and had an arm that investigated the effect of a monotherapy on vitiligo at 6 months. Studies of the randomized and observational designs were included. The retrieved data were sufficient to analyze networks for phototherapy, Janus kinase inhibitors (JAKIs), calcineurin inhibitors, cyclosporine, corticosteroids, azathioprine, and minocycline. Modalities' effects, in each of the networks, were ranked with the surface under the cumulative ranking curve (SUCRA) metric; league tables were produced to depict agents' pairwise relative effects. Our secondary outcome was discontinuation due to any adverse event (AE) at 6 months. No significant differences are observed among JAK inhibitors; however, upadacitinib, cyclosporine, ritlecitinib, and dexamethasone are significantly more effective than minocycline. Psoralen (oral) + ultraviolet A (PUVA) and narrow band ultraviolet B (NB-UVB) regimens show similar efficacy for repigmentation. Ruxolitinib 1.5% cream (once or twice daily), ruxolitinib 0.5% cream once daily, and ruxolitinib 0.15% cream once daily for 6 months do not differ significantly in efficacy. Mometasone furoate and tacrolimus 0.1% ointment are more effective than tacrolimus 0.03%.