Nonsurgical repigmentation therapies in vitiligo - Meta-analysis of the literature

Objective: To assess the effectiveness and safety of nonsurgical repigmenta tion therapies in localized and generalized vitiligo by means of a meta-ana lysis. Data Sources: Computerized searches of bibliographic databases, a complemen tary manual literature search, and contacts with researchers and pharmaceut ical firms. Study Selection: Predefined selection criteria were applied to both randomi zed and nonrandomized controlled trials. Data Extraction: Two investigators independently assessed the articles for inclusion. When there was a disagreement, a third investigator was consulte d. Data Synthesis: Sixty-three studies were found on therapies for localized v itiligo. Of these, 10 of 11 randomized controlled trials and 29 of 110 pati ent series were included. One hundred seventeen studies on therapies for ge neralized vitiligo were found. Of these, 10 of 22 randomized controlled tri als and 46 of 231 patient series were included. Among randomized controlled trials on localized vitiligo, the pooled odds ratio vs placebo was signifi cant for topical class 3 corticosteroids (14.32; 95% confidence interval [C I], 2.45-83.72). In the patient series, topical class 3 and class 4 cortico steroids carried the highest mean success rates (56% [95% CI, 50%-62%] and 55% [95% CI, 49%-61%], respectively). Side effects were reported mostly wit h topical psoralen and intralesional and class 4 corticosteroids. In the ra ndomized controlled trials on generalized vitiligo, the odds ratio vs place bo was significant for oral methoxsalen plus sunlight (23.37; 95% CI, 1.33- 409.93), oral psoralen plus sunlight (19.87; 95% CI, 2.37-166.32), and oral trioxsalen plus sunlight (3.75; 95% CI, 1.24-11.29). In the series, the hi ghest mean success rates were achieved with narrowband UV-B (63%; 95% CI, 5 0%-76%), broadband UV-B (57%; 95% CI, 29%-82%), and oral methoxsalen plus U V-A therapy (51%; 95% CI, 46%-56%). Oral methoxsalen plus W-A was associate d with the highest rates of side effects. No side effects were reported wit h W-B therapy. Conclusions: Class 3 corticosteroids and UV-B therapy are the most effectiv e and safest therapies for localized and for generalized vitiligo, respecti vely.