Comparative efficacy and safety of tranexamic acid for melasma by different administration methods: A systematic review and network meta-analysis

BackgroundTranexamic acid (TA) is a new and promising drug for the treatment of melasma.ObjectivesThis network meta-analysis aims to compare the efficacy and safety of various ways of administration of TA on melasma.MethodsWe collected researches from PubMed, EMBASE, Cochrane Library and Web of Science. Melasma area severity index (MASI) is used to evaluate the severity of melasma. After treatment with different TA administration methods, a difference in MASI is named Delta MASI. We evaluate the curative effect by comparing the Delta MASI of different TA administration methods at a certain time point.ResultsAt the Weeks 4, 8, and 12 and the last follow-up, the Delta MASI of oral TA combined with routine topical agents (oTA + RTA) was higher than that of intradermal TA (iTA), topical TA (tTA) as well as microneedling TA (MNsTA), with statistical significance. At the 8th week, the Delta MASI of oTA was higher than that of iTA, with statistical significance. Compared with placebo, oTA showed statistically significant differences at Week 4, while tTA, iTA, and MNsTA showed statistically significant differences starting from Week 8.ConclusionsAmong various ways of administration of TA, oTA + RTA has the best effect on melasma. In the short term, the curative effect of oTA is better than that of iTA, and the onset time of oTA is faster than that of tTA, iTA and MNsTA. In the long run, the curative effect of TA alone has nothing to do with the mode of administration.