Comparison of topical treatment for vitiligo: A systematic review and network meta-analysis
Shin-Shin Ho, Jen-Yu Wang, Hui-En Chuo, Ping-Hsun Lu, Po-Hsuan LuAbstract
Background:
Vitiligo is an autoimmune-related pigment disorder. Previous studies have demonstrated the therapeutic effects of phototherapy, topical treatments, and systemic immunomodulators in promoting repigmentation in patients with vitiligo. A network meta-analysis can provide the relative efficacy of various topical medications for which head-to-head clinical trials are lacking.
Objectives:
To identify the optimal topical treatments for repigmentation in vitiligo patients.
Methods:
A systematic search of electronic databases up to July 2024 identified randomized controlled trials involving vitiligo patients receiving topical treatment. The primary outcome was a 50% improvement in the Vitiligo Area Scoring Index (VASI50), a secondary analysis focused on the VASI75. Subgroup analyses were also conducted.
Results:
Thirty randomized controlled trials with 2,031 patients were included in the network meta-analysis. Compared with the control groups, the most effective monotherapy for achieving VASI50 was 0.05% clobetasol (risk ratio [RR]: 11.44; 95% confidence interval [CI]: 5.14–25.47), followed by 0.01% bimatoprost, 0.1% tacrolimus, and 0.1% mometasone, respectively. Among combination therapies, 0.05% clobetasol plus 5% fluorouracil (RR: 42.89; 95% CI: 11.71–157.19) was the most effective. Subgroup analyses yielded consistent findings, with 0.05% clobetasol plus 5% fluorouracil and 0.05% clobetasol monotherapy remaining the top treatments, except in facial lesion treatments, where 0.01% bimatoprost ranked highest.
Conclusion:
Our study provides a comparative efficacy ranking of different topical treatments for vitiligo and supports site-specific treatment strategies. Overall, 0.05% clobetasol plus 5% fluorouracil demonstrated the highest effectiveness for repigmentation, whereas 0.05% clobetasol was the most effective monotherapy, except in facial lesion treatment, for which 0.01% bimatoprost was superior.