The efficacy of 308-nm excimer laser/light (EL) and topical agent combination therapy versus EL monotherapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials (RCTs)

Background: Combination therapies of excimer laser/light (EL) and various topical agents are widely used in the treatment of vitiligo. Objective: We sought to compare the efficacy of EL and topical agent combination therapy versus EL monotherapy for vitiligo. Methods: Manual searches of reference lists and computerized searches of the MEDLINE, EMBASE, and Cochrane library (from inception through December 15, 2014) were conducted to identify randomized controlled trials that assessed the efficacy of EL alone or in combination with topical agents for vitiligo. The primary outcome was treatment success (>= 75% repigmentation), and the secondary outcome was treatment failure (<25% repigmentation); meta-analyses were performed when possible. Results: We analyzed 8 randomized controlled trials comprising a total of 425 patches/patients. The combination of EL and topical calcineurin inhibitors (4 studies: relative risk 1.93, 95% confidence interval 1.28-2.91; number needed to treat 4.5, 95% confidence interval 2.9-10) was superior to EL monotherapy for vitiligo. There was insufficient evidence to support beneficial effects of topical vitamin-D3 analogs (3 studies) and corticosteroids (1 study). Limitations: These findings are based on small numbers of randomized controlled trials and heterogeneities among included studies are another limitation. Conclusion: Topical calcineurin inhibitors in conjunction with EL are more effective compared with EL monotherapy.