Vitamin D analogs combined with different types of phototherapy in the treatment of vitiligo: A systematic review of randomized trials and within-patient studies.

OBJECTIVES

This systematic review was to assess the effects of phototherapies (psoralen plus ultraviolet A [PUVA], narrowband ultraviolet B [NBUVB], or 308 nm excimer laser [EL]) in combination with vitamin D analogs compared with phototherapy alone on vitiligo.

METHODS

Four databases were searched up to 18 October 2021 for relevant studies. The primary outcome was the proportion of response to treatment (≥50% repigmentation) after treatment. Secondary outcomes included excellent response, treatment failure, and safety. The risk ratio (RR) was used as the estimate measure in meta-analyses.

RESULTS

Fourteen studies (n = 642) were included. The meta-analyses showed that the combination of either calcipotriol or tacalcitol and NBUVB was superior to NBUVB monotherapy for vitiligo in the proportion of response to treatment (RR 1.67, 95% CI 1.21-2.31), treatment failure (RR 0.43, 95% CI 0.22-0.85), and excellent response (RR 7.48, 95% CI 1.09-51.13). The tacalcitol was more effective than calcipotriol in increasing the rate of response to treatment when combined with NBUVB (RR 2.25 versus 1.24, interaction p = 0.002). The results did not support better efficacy with the combination of PUVA or EL with vitamin D analogs over phototherapy alone in all outcomes. Adverse events were minor and transient.

CONCLUSIONS

The current evidence suggests that the additional use of topical calcipotriol or tacalcitol to NB-UVB may increase the treatment effect of vitiligo, and the effect of tacalcitol is greater than that of calcipotriol. None of the vitamin D analogs were found to enhance the efficacy of PUVA or EL for vitiligo.