Effects and safety of triamcinolone acetonide-controlled common therapy in keloid treatment: a Bayesian network meta-analysis

Figures & data

Figure 1 Flow diagram of the study selection process.

Figure 2 Risk of bias of the included randomized controlled trials (judgments about each risk-of-bias item for each included study: +, low risk; −, high risk; ?, unclear risk).

Figure 3 Network of randomized controlled trials comparing different adjuvant therapies for keloid treatment.

Notes: The thickness of the connecting lines represents the number of trials between each comparator, and the size of each node corresponds to the number of subjects who received the same pharmacological agent (sample size). (A: TAC; B: placebo; C: PDL; D: 5-FU; E: silicone; F: verapamil; G: TAC+5-FU; H: TAC+5-FU+PDL).
Abbreviations: TAC, triamcinolone acetonide; PDL, pulsed dye laser; 5-FU, 5-fluorouracil.

Table 1 Characteristics of included studies

Study	No of participants	Treatments
		Treatment 1	Age (years)	Case/n	Treatment 2	Age (years)	Case/n	Treatment 3	Age (years)	Case/n	Treatment 4	Age (years)	Case/n	Treatment 5	Age (years)	Case/n
Tan et al^Citation12	60	Placebo	19.0–40.0	0/20	TAC	19.0–40.0	16/20	Silicone	19.0–40.0	11/20
Asilian et al^Citation13	66	TAC	23.4±8.0	13/23	TAC+5-FU	25.3±11.9	5/23	TAC+5-	25.5±13.0	4/20
Manuskiatti and Fitzpatrick^Citation14	40	Placebo	25.0–74.0	6/10	TAC	25.0–74.0	10/10	PDL	25.0–74.0	8/10	5-FU	25.0–74.0	10/10	TAC+5-FU	25.0–74.0	9/10
Sadeghinia and Sadeghinia^Citation15	40	TAC	45.0±8.2	10/20	TAC+5-FU	44.3±9.4	19/20
Khan et al^Citation16	150	TAC	29.5±9.3	51/75	TAC+5-FU	27.6±6.7	63/75
Darougheh et al^Citation20	40	TAC	23.4±8.0	4/20	TAC+5-FU	25.2±11.9	11/20
Margaret et al^Citation17	54	TAC	42.1±9.8	15/27	Verapamil	41.4±12.5	20/27
Ahuja and Chatterjee^Citation18	40	TAC	15.0–60.0	9/20	Verapamil	15.0–60.0	11/20
Danielsen et al^Citation19	30	TAC	18.0–53.0	6/15	Verapamil	18.0–53.0	9/15
Hatamipour et al^Citation21	47	5-FU	19.0–47.0	1/24	Silicone	19.0–47.0	5/23

Note: Data presented as mean±SD or mean age range.

Abbreviations: TAC, triamcinolone acetonide; 5-FU, 5-fluorouracil; PDL, pulsed dye laser.

Table 2 Summary ORs of TAC and heterogeneity for each direct comparison

Comparison	OR (95% CI)	P-heterogeneity	I^2	τ^2
Placebo vs TAC	1.86 (1.12–2.61)	0.697	<0.01%	<0.001
PDL vs TAC	1.32 (0.53–3.30)	0.286	20.7%	0.112
5-FU vs TAC	1.13 (0.48–2.68)	0.723	<0.01%	0.317
Silicone vs TAC	1.28 (0.59–2.78)	0.790	<0.01%	0.713
Verapamil vs TAC	1.86 (0.67–5.14)	0.211	29.9%	0.541
TAC+5-FU vs TAC	0.77 (0.38–1.58)	0.160	37.0%	0.759
TAC+5-FU+PDL vs TAC	0.80 (0.16–4.03)	0.146	35.4%	0.951
PDL vs placebo	0.34 (0.27–0.43)	0.814	<0.01%	<0.001
Silicone vs placebo	0.40 (0.29–0.54)	0.660	<0.01%	<0.001
5-FU vs placebo	0.37 (0.26–0.52)	0.620	<0.01%	<0.001
TAC+5-FU vs placebo	0.49 (0.28–0.85)	–	–	<0.001
5-FU vs PDL	1.45 (0.42–5.00)	0.303	17.6%	0.951
TAC+5-FU vs PDL	1.25 (0.42–3.67)	–	–	0.899
Silicone vs 5-FU	0.86 (0.30–2.41)	–	–	0.691
TAC+5-FU vs 5-FU	0.60 (0.24–1.49)	–	–	0.644
TAC+5-FU+PDL vs TAC+5-FU	1.09 (0.39–2.97)	–	–	0.926

Notes: Bold values indicate P<0.05. “–“ indicates data not available.

Abbreviations: TAC, triamcinolone acetonide; PDL, pulsed dye laser; 5-FU, 5-fluorouracil.

Table 3 Network meta-analysis comparisons

Comparison	Placebo	PDL	5-FU	TAC	Silicone	Verapamil	TAC+5-FU	TAC+5-FU+PDL
Placebo	1	5.20 (1.15, 9.61)	10.0 (1.30, 39.0)	27.0 (5.90, 57.0)	21.0 (4.90, 34.0)	17.0 (5.50, 25.0)	28.0 (4.50, 49.0)	11.0 (1.38, 21.0)
PDL	0.30 (0.06, 0.55)	1	2.40 (0.01, 28.0)	0.02 (0.01, 2.80)	2.60 (0.05, 15.0)	5.10 (0.10, 29.0)	0.73 (0.07, 8.50)	0.25 (0.01, 6.80)
5-FU	0.32 (0.05, 0.78)	0.19 (0.01, 22.0)	1	0.40 (0.01, 42.0)	8.11 (0.16, 39.0)	1.50 (0.23, 9.20)	2.40 (0.20, 26.0)	0.88 (0.03, 23.0)
TAC	0.08 (0.00, 0.18)	2.20 (0.12, 20.0)	0.40 (0.02, 8.50)	1	1.20 (0.03, 23.0)	2.00 (0.12, 35.0)	1.10 (0.07, 8.00)	0.38 (0.01, 29.0)
Silicone	0.20 (0.01, 0.40)	6.50 (0.32, 16.0)	2.80 (0.02, 23.0)	1.20 (0.03, 23.0)	1	0.29 (0.12, 4.70)	2.90 (0.33, 24.0)	1.10 (0.04, 20.0)
Verapamil	0.23 (0.01, 0.46)	1.10 (0.36, 11.0)	0.69 (0.11, 4.20)	2.00 (0.12, 35.0)	5.30 (0.24, 26.0)	1	1.60 (0.25, 11.0)	0.53 (0.03, 11.0)
TAC+5-FU	0.12 (0.01, 0.24)	5.30 (0.30, 19.0)	0.43 (0.04, 5.10)	1.10 (0.07, 8.00)	0.34 (0.04, 2.70)	0.65 (0.10, 3.80)	1	0.37 (0.02, 4.60)
TAC+5-FU+PDL	0.46 (0.27, 0.77)	2.10 (0.03, 31.0)	1.10 (0.03, 37.0)	0.38 (0.01, 29.0)	0.93 (0.04, 25.0)	1.80 (0.10, 41.0)	2.50 (0.18, 46.0)	1

Note: Data presented as OR (95% CI).

Abbreviations: PDL, pulsed dye laser; 5-FU, 5-fluorouracil; TAC, triamcinolone acetonide.

Figure 4 SUCRA values, expressed as percentages, ranking the therapeutic effects and safety of treatments for keloids.

Notes: For efficacy and safety assessment, the pharmacological agent with the highest SUCRA value would be the most efficacious and safe treatment (A: TAC; B: placebo; C: PDL; D: 5-FU; E: silicone; F: verapamil; G: TAC+5-FU; H: TAC+5-FU+PDL).
Abbreviations: SUCRA, surface under the cumulative ranking curve; TAC, triamcinolone acetonide; PDL, pulsed dye laser; 5-FU, 5-fluorouracil.

Figure 5 Comparison-adjusted funnel plot for the network meta-analysis.

Notes: The red line suggests the null hypothesis that the study-specific effect sizes do not differ from the respective comparison-specific pooled effect estimates. Different colors represent different comparisons (A: TAC; B: placebo; C: PDL; D: 5-FU; E: silicone; F: verapamil; G: TAC+5-FU; H: TAC+5-FU+PDL).
Abbreviations: TAC, triamcinolone acetonide; PDL, pulsed dye laser; 5-FU, 5-fluorouracil.

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