Efficacy of photodynamic therapy in the treatment of actinic keratosis: a network meta-analysis

Abstract

Abstract Background: Photodynamic therapy (PDT) is a highly 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. A network meta-analysis (NMA) allows for comparison between treatments not directly compared in randomized controlled trials (RCTs). This study’s objective was to compare the efficacy of different PDTs against AK lesions based on complete response rate (CR) by conducting a NMA. Methods: The RCTs on the treatment of AK using PDT were screened, and a Bayesian model was developed using GeMTC 0.14.3 software to perform a NMA. The subgroups demarcated on the basis of the light sources and photosensitizers were also compared. RevMan 5.4.0 software was used to compare the outcome measure of different light sources in terms of relative risk ratio (RR) and a 95% confidence interval (CI). The therapeutic effects of different photosensitizers were compared using R 4.2.1 software and gemtc package version 1.0-1. The quality of the included literature was evaluated using the risk of bias assessment tool in RevMan 5.4.0, and the network plots between studies were drawn using STATA 16.0 software. Results: Twenty-six trials involving 2285 patients and 14 treatments were included in the NMA. The results of the NMA showed that ablative fractional laser (AFL)-assisted methyl 5-aminolevulinic acid (MAL)-light-emitting diode (LED)-PDT had the best possible efficacy (Rank 1=0.56), followed by calcipotriol (CAL)-assisted MAL-LED-PDT (Rank 1=0.34) and 5-aminolaevulinic acid (ALA)-LED-PDT (Rank 1=0.05). The subgroup analysis showed that MAL-based PDT had better efficacy when using LED versus other light sources (RR：1.05，95% CI：1.03-1.07), and LED-based PDT resulted in the best possible efficacy when using ALA (Rank 1=0.47) versus other photosensitizers. Conclusions: AFL combined with MAL-LED-PDT is most likely the best treatment option for AK. In case of monotherapies, PDT based on LED light source and ALA photosensitizer is a suitable choice.