Comparative effectiveness among available treatments in difficult-to-treat port-wine stains (PWS): a Network Meta-Analysis of observational evidence

Figures & data

Table 1. Characteristics of the included studies.

Author (year)	Site of study	Type of study	Study size (n)	Age	Female (%)	Type of PWS	Head and neck (%)	Intervention (n)	≥25% Clearance (n)
Chang (2002) (37)	Taiwan (Single center)	Comparative (retrospective, blinded evaluation)	31	25.4¶ years	66	Hypertrophy	100	LPDL 585 nm (17)	15
								LPDL >585 nm (14)	7
Woo (2004) (38)	U.K. (Single center)	Comparative (prospective, independent evaluation)	110	40.2 ± 13.1¶ (range 18–68) years	50	Resistant	68.2	SPDL 585 nm (22)	1
								LPDL >585 nm (44)	5
								532 nm NdYAG (44)	6
Yung (2005) (39)	U.K. (Single center)	Comparative (prospective, blinded evaluation)	36	35¶ (range 17–59) years	66.7	Resistant	65	LPDL 585 nm (9)	5
								LPDL >585 nm (27)	10
Yang (2005) (40)	Philippines (Single center)	Comparative (prospective, blinded evaluation)	8	48¶ years	NR	Hypertrophy	100	LPDL >585 nm (2)	1
								1064 nm NdYAG (6)	4
Babilas (2010) (41)	Germany (Single center)	Comparative (prospective, three independent and blinded evaluation)	74	28.4 ± 18.9¶ (range 2–69) years	71.4	Resistant	72	SPDL 585 nm (12)	1
								LPDL 585 nm (9)	4
								LPDL >585 nm (23)	9
								IPL (30)	18
Carlsen (2016) (42)	Denmark (Single center)	Randomized side-by-side control	28	61.7 ± 16.3¶ (range 33–78) years	28.6	Hypertrophy	71.4	755 nm alexandrite (21)	16
								Control (7)	0
Horbach (2019) (62)	Netherlands (Single center)	Randomized within-patient controlled (blinded evaluation)	15	56.6 ± 16.5¶ (range 36–73) years	26.7	Hypertrophy	20	Enhanced method (Drug delivery system and Bleomycin) (5)	4
								Medication (Bleomycin) (5)	0
								Control (5)	0
Artzi (2019) (19)	Israel (Single center)	Comparative (case series, blinded evaluation)	6	12.7 ± 3.1¶ 10–16 years	66.7	Resistant	66.7	Enhanced method (Drug delivery system and Rapamycin and 595 nm PDL) (3)	3
								Medication (Rapamycin and 595 nm PDL) (3)	0

PWS: Port-Wine stain; ¶: mean or mean ± SD; IPL: intense pulse light; NR: not reported; LPDL: long-pulsed dye laser; SPDL: short-pulsed dye laser; 1064NdYAG: 1064 nm neodymium: YAG; 532NdYAG: 532 nm neodymium: YAG.

Figure 1. Networks of all treatment comparisons (5 studies, 15 treatment pairs, 259 difficult-to-treat PWS). the size of nodes corresponds to the number of treatment trials. Treatment pairs with direct evidence are connected with solid black lines. The thickness of lines corresponds to the number of participants within each comparison.

Figure 2. The surface under the cumulative ranking curve (SUCRA) of each available treatment modality for clinical improvements.

Table 2. League table of odds ratio (OR) for clinical improvements among all available pairwise comparisons.

4.36

SPDL 585	4.36	3.32		8.80	16.50
	(0.91, 20.84)	(0.37, 29.42)		(0.77, 100.26)	(1.88, 145.02)
3.97	LPDL >585	1.23	2.00	2.48	2.33
(0.84, 18.78)		(0.35, 4.38)	(0.08, 51.59)	(0.92, 6.65)	(0.77, 7.09)
4.57	1.15	532NdYAG
(0.79, 26.47)	(0.33, 3.96)
7.94	2.00	1.74	1064NdYAG
(0.22, 290.98)	(0.08, 51.52)	(0.05, 56.26)
9.95	2.50	2.18	1.25	LPDL 585	1.88
(1.75, 56.62)	(0.99, 6.35)	(0.47, 10.10)	(0.04, 36.82)		(0.42, 8.44)
11.81	2.97	2.58	1.49	1.19	IPL
(2.15, 64.89)	(1.06, 8.36)	(0.53, 12.56)	(0.05, 45.02)	(0.35, 3.98)

Within this league table, SPDL 585 is set as a reference treatment. The bolded values indicate the statistical significance of the OR between pairwise comparison (p value <0.05). The upper-right portion of the league table represents the direct OR for clinical improvements from pairwise meta-analysis direct evidence pooling. The OR value higher than one indicates that the treatment specified in column is superior to the treatment specified in row. The lower-left portion of the league table represents the OR for clinical improvements from Network Meta-Analysis (NMA) evidence pooling. The OR value of more than one indicates that the treatment specified in row is superior to the treatment specified in column. Treatments are arranged in order of the ranking by NMA from best (lower-right) to worst (upper-left). IPL: intense-pulsed light; LPDP: long-pulsed dye laser; SPDL: short-pulsed dye laser; 1064NdYAG: 1064 nm neodymium: YAG; 532NdYAG: 532 nm neodymium:YAG.

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Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.