Review ArticleSystematic Review

Comparative Efficacy of Pharmacological Treatments for Acne Vulgaris: A Network Meta-Analysis of 221 Randomized Controlled Trials

Chung-Yen Huang, I-Jing Chang, Nicole Bolick, Wan-Ting Hsu, Chin-Hua Su, Tyng-Shiuan Hsieh, I-Hsuan Huang and Chien-Chang Lee
The Annals of Family Medicine July 2023, 21 (4) 358-369; DOI: https://doi.org/10.1370/afm.2995

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Flow diagram of selection of included articles.

  • Figure 2a.
    Figure 2a.

    Estimates of the percentage reduction in total lesion count for different treatments compared with placebo in the primary analysis.

    AA = azelaic acid; Abx = antibiotic; BPO = benzoyl peroxide; CMA = chlormadinone acetate; CPA = cyproterone acetate; DRSP = drospirenone; DSG = desogestrel; EE = ethinyl estradiol; LNG = levonorgestrel; MD = mean difference; NGM = norgestimate; Zn = zinc.

    Note: Forest plots of MD and 95% CI in percentage reduction of compared with placebo in a random effects model.

  • Figure 2b.
    Figure 2b.

    Estimates of the percentage reduction in inflammatory lesion count for different treatments compared with placebo in the primary analysis.

    AA = azelaic acid; Abx = antibiotic; BPO = benzoyl peroxide; CMA = chlormadinone acetate; CPA = cyproterone acetate; DRSP = drospirenone; DSG = desogestrel; EE = ethinyl estradiol; LNG = levonorgestrel; MD = mean difference; NGM = norgestimate; Zn = zinc.

    Note: Forest plots of MD and 95% CI in percentage reduction compared with placebo in a random effects model.

  • Figure 2c.
    Figure 2c.

    Estimates of the percentage reduction in noninflammatory lesion count for different treatments compared with placebo in the primary analysis.

    AA = azelaic acid; Abx = antibiotic; BPO = benzoyl peroxide; CMA = chlormadinone acetate; CPA = cyproterone acetate; DRSP = drospirenone; DSG = desogestrel; EE = ethinyl estradiol; LNG = levonorgestrel; MD = mean difference; NGM = norgestimate; Zn = zinc.

    Note: Forest plots of MD and 95% CI in percentage reduction compared with placebo in a random effects model.

  • Figure 3a.
    Figure 3a.

    Forest plot estimates of the percentage reduction in total lesion count compared with placebo in the simplified network.

    AA = azelaic acid; Abx = antibiotic; BPO = benzoyl peroxide; COC = combination oral contraceptives; MD = mean difference.

    Note: Forest plots of MD and 95% CI in percentage reduction compared with placebo in a random effects model.

  • Figure 3b.
    Figure 3b.

    Estimates of the percentage reduction in inflammatory lesion count compared with placebo in the simplified network.

    AA = azelaic acid; Abx = antibiotic; BPO = benzoyl peroxide; COC = combination oral contraceptives; MD = mean difference.

    Note: Forest plots of MD and 95% CI in percentage reduction compared with placebo in a random effects model.

  • Figure 3c.
    Figure 3c.

    Estimates of the percentage reduction in noninflammatory lesion count compared with placebo in the simplified network.

    AA = azelaic acid; Abx = antibiotic; BPO = benzoyl peroxide; COC = combination oral contraceptives; MD = mean difference.

    Note: Forest plots of MD and 95% CI in percentage reduction compared with placebo in a random effects model.

  • Figure 4a.
    Figure 4a.

    Estimates of the treatment success evaluated by Investigator’s Global Assessment compared with placebo.

    AA = azelaic acid; Abx = antibiotic; BPO = benzoyl peroxide; DRSP = drospirenone; EE = ethinyl estradiol; IGA = Investigator’s Global Assessment; LNG = levonorgestrel; OR = odds ratio.

    Note: Forest plots of OR and 95% CI for treatment success measured by IGA compared with placebo in a random effects model.

  • Figure 4b.
    Figure 4b.

    Estimates of the discontinuations due to adverse events compared with placebo.

    AA = azelaic acid; Abx = antibiotic; AE = adverse event; BPO = benzoyl peroxide; CMA = chlormadinone acetate; CPA = cyproterone acetate; DRSP = drospirenone; DSG = desogestrel; EE = ethinyl estradiol; LNG = levonorgestrel; NGM = norgestimate; OR = odds ratio; Zn = zinc.

    Note: Forest plots of OR and 95% CI for discontinuations due to AEs compared with placebo in a random effects model.

  • Figure 5a.
    Figure 5a.

    Biplots of reduction in inflammatory and noninflammatory lesion counts in the primary analysis.

    AA = azelaic acid; Abx = antibiotic; BPO = benzoyl peroxide; CMA = chlormadinone acetate; CPA = cyproterone acetate; DRSP = drospirenone; DSG = desogestrel; EE = ethinyl estradiol; LNG = levonorgestrel; NGM = norgestimate; Zn = zinc.

    Note: Percentage reduction in inflammatory lesion count (x axis) vs percentage reduction in noninflammatory lesion count (y axis) compared with placebo.

  • Figure 5b.
    Figure 5b.

    Bioplots of reduction in inflammatory and noninflammatory lesion counts in the simplified model.

    AA = azelaic acid; Abx = antibiotic; BPO = benzoyl peroxide; COC = combined oral contraceptives.

    Note: Percentage reduction in inflammatory lesion count (x axis) vs percentage reduction in noninflammatory lesion count (y axis) compared with placebo.

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