Comparison of NB-UVB Combination Therapy Regimens for the Treatment of Vitiligo

Zhu et al (2023) noted that vitiligo is an autoimmune disease and some guidelines for the management of vitiligo encouraged the use of NB-UVB combination therapies to enhance re-pigmentation.  In a systematic review and network meta-analysis, these researchers compared the effectiveness of current NB-UVB combination regimen at the improvement in re-pigmentation.  They searched the electronic databases for RCTs related to NB-UVB combination therapy for vitiligo till October 2022; STATA15.0 software was employed to conduct data analysis.  A total of 28 eligible studies involving 1,194 participants were enrolled in the analysis.  The NMA results revealed that compared with NB-UVB, carboxytherapy (OR = 32.35, 95 % CI: 1.79 to 586.05), Er: YAG laser+ topical 5% 5-FU (OR = 10.74, 95 % CI: 4.05 to 28.49), needling/micro-needling (OR = 3.42, 95 % CI: 1.18 to 9.88), betamethasone intra-muscular injection (OR = 3.08, 95 % CI: 1.17 to 8.13), topical tacrolimus (OR = 2.54, 95 % CI: 1.30 to 4.94), and oral Chinese herbal medicine compound (OR = 2.51, 95 % CI: 1.40 to 4.50) integrated with NB-UVB were more effective in excellent to complete re-pigmentation response rate (75 %or higher).  In addition, NB-UVB+ Er: YAG laser+ topical 5 % 5-FU (OR = 0.17, 95 % CI: 0.04 to 0.67) and NB-UVB+ needling/micro-needling (OR = 0.24, 95 % CI: 0.06 to 0.88) were less likely evaluated as ineffective re-pigmentation response (25 % or less).  The authors concluded that all combination therapies ranked higher than NB-UVB monotherapy in inducing successful re-pigmentation and avoiding failed treatment in patients with vitiligo.  Comprehensive consideration, NB-UVB+ Er: YAG laser+ topical 5 % 5-FU and NB-UVB+ needling/micro-needling would be the preferred therapeutic approaches.