Comparative Efficacy of Drug Interventions for Keloids: A Network Meta-analysis

source extracted confidence: high 2026-04-09
#humans #keloid #botulinum-toxins-type-a #drug-therapy-combination #treatment-outcome

Comparative Efficacy of Drug Interventions for Keloids: A Network Meta-analysis

Yang et al., 2024 | Ann Plast Surg | Systematic Review

Citation

Yang Hsi-An, Jheng Wun-Long, ... Lee Jian-Jr. Comparative Efficacy of Drug Interventions for Keloids: A Network Meta-analysis. Ann Plast Surg. 2024-Jan-01;92(1S Suppl 1):S52-S59. doi:10.1097/SAP.0000000000003759

Abstract

BACKGROUND: Keloids are common benign skin lesions originating from a disorganized fibroproliferative collagen response; these lesions often lead to both physical and psychological problems. The optimal treatment for keloids is yet to be standardized. Intralesional injection, which is simple and nontraumatic, is one of the most commonly used treatment modalities for these lesions. In this study, we compared 5 different drugs (intralesional injections) for the treatment of keloids in terms of efficacy. METHODS: We systemically searched relevant studies on PubMed, EMBASE, and Cochrane Library. Randomized clinical trials on the safety and efficacy of triamcinolone acetonide (TAC), 5-fluorouracil (5-FU), botulinum toxin A (BTA), verapamil, and bleomycin were included in this study. RESULTS: This network meta-analysis included a total of 1114 patients from 20 randomized controlled trials. Botulinum toxin A alone and TAC plus 5-FU exhibited significantly better efficacy than did 5-FU, TAC, and verapamil. No significant difference in efficacy between BTA alone and TAC combined with 5-FU was observed. No significant differences were noted in the adverse event rate between BTA, TAC plus 5-FU, 5-FU, and TAC. Furthermore, we performed surface under the cumulative ranking curve analyses to predict the rank of each intervention (by efficacy and adverse event rate). The predicted ranking by efficacy was as follows: TAC plus 5-FU, BTA, bleomycin, TAC, 5-FU, and verapamil; the predicted ranking by adverse events was as follows: TAC, 5-FU, TAC plus 5-FU, and BTA. Funnel plot analysis revealed no publication bias. CONCLUSIONS: Botulinum toxin A and TAC plus 5-FU appear to have outstanding therapeutic efficacy for keloids. The rate of adverse events was similar among BTA, TAC, 5-FU, and TAC plus 5-FU. Nonetheless, additional reviews of rigorous, large-scale randomized controlled trials are warranted for further validation of our findings.

Key Findings

This network meta-analysis included a total of 1114 patients from 20 randomized controlled trials. Botulinum toxin A alone and TAC plus 5-FU exhibited significantly better efficacy than did 5-FU, TAC, and verapamil. No significant difference in efficacy between BTA alone and TAC combined with 5-FU was observed. No significant differences were noted in the adverse event rate between BTA, TAC plus 5-FU, 5-FU, and TAC. Furthermore, we performed surface under the cumulative ranking curve analyses to

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 1114
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Keloid
  • Botulinum Toxins, Type A
  • Drug Therapy, Combination
  • Treatment Outcome
  • Fluorouracil
  • Injections, Intralesional
  • Bleomycin
  • Verapamil
  • Randomized Controlled Trials as Topic

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Systematic Review, Journal Article, Network Meta-Analysis
  • Vertical: collagen

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09