AUTHOR=Yang Sha , Luo Yujia J. , Luo Cong 

TITLE=Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.691628

DOI=10.3389/fmed.2021.691628

ISSN=2296-858X

ABSTRACT=Objective:
To evaluate the efficacy of different injection and topical treatment strategies for hypertrophic scar and keloid.
Data Sources:
PubMed, Medline, Embase, Scopus, the Cochrane Central Register of Controlled Trials and WHO International Clinical Trials Registry Platform were searched for randomized clinical trials from databasr inception through November 2020.
Study Selection:
We included randomized clinical trials evaluating different strategies, including Triamcinolone Acetonide (TAC) or Verapamil (VER) or 5-Fluorouracil (5-FU) or Botulinum toxin A (TBA) or Bleomycin (BLM) or Silicone for patients with pathological scars.
Data Extraction and Synthesis: 
The reporting of this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. The overall effect was pooled using the random-effects model.  Network meta-analysis was used a random-effects consistency model to pool evidence from both indirect and direct  comparisons. Treatment strategies were ranked using surface under the cumulative ranking (SUCRA) probabilities.
Findings: 
29 randomized controlled trials at moderate to low risk of bias (2009 patients; age range, 10-81 years) were included. Network meta-analysis showed the efficacy of triamcinolone acetonide combined with botulinum toxin type A was best in the treatment of pathological scar among injection and topical treatment strategies. Compared with triamcinolone acetonide, only TAC combined with 5-FU and TAC combined with BTA can significantly improve the clinical efficiency, but there was no statistically significant difference between other treatment strategies. Moreover, the order of efficacy predicted by the SUCRA curve based efficacy was as follow: TAC+BTA (82.2%)＞TAC+5-FU (69.8%)＞BTA (67.3%)＞5-FU+Silicone (59.4%)＞TAC+Silicone (58.3%)＞5-FU (49.8%)＞BLM (42.0%)＞TAC (26.7%)＞VER (26.2%)＞Silicone (18.3%). Further, the funnel diagram do not found publication bias.
Conclusions and Relevance: 
we want to first recommend intralesional injection of triamcinolone acetonide combined with botulinum toxin A. Secondly, triamcinolone acetonide combined with 5-fluorouracil. But for patients who cannot tolerate the side effects we recommend the use of silicone gels in combination with triamcinolone acetonide. However, the conclusion needs to be further confirmed by further research.