| BackgroundAcne is a common dermatologic disease that affects adolescents and is associated with significant impairment of their physical and mental health.Tetracyclines are common medications of acne for their antibacterial and anti-inflammatory properties.However,there are concerns with systemic side effects of tetracyclines and bacterial resistance caused by oral antibiotics is getting worse globally,which have limited the use of tetracyclines in moderate to severe acne patients.Recently,researchers have developed topical formulations of minocycline to treat moderate to severe acne and found that they are of both efficacy and safety,which lacks meta-analysis and needs more related evidence.ObjectiveTo conduct a meta-analysis that evaluates the efficacy and safety of topical formulations of minocycline for moderate to severe acne vulgaris and provide more reliable evidence-based information.MethodsFollowing Chinese and English databases were searched based on key words and search strategies for related randomized controlled trials(RCTs)up to 31st March,2020:CNKI,WanFang,CBM,VIP,PubMed,Embase,the Cochrane Library.RCTs are finally included after deduplication,screening and reading.We assessed the risk of bias by using Cochrane Collaboration’s risk of bias tool.In addition to baseline data,we also extracted efficacy end points,like the rate of IGA treatment success at week 12,the number of inflammatory and noninflammatory lesion counts at week 12,and safety end points,like the rate of treatment-related TEAE at week 12,the rate of participant discontinuation secondary to TEAE and the rate of facial local intolerability at week 12.Stata 14.0 software was used to combine date,test heterogeneity and perform sensitivity analysis.What’s more,Stata 14.0,Revman 5.3 and TSA 0.9.5.10 Bete sofewares were applied for drawing forest plots,risk of bias graphs and trial sequential analysis images respectively.ResultsThe searching of these datebases yielded 487 Chinese articles and 182 English articles,of which 337 duplicates were excluded.Removing 36 articles of non-RCT studies and 291 articles which did not fulfill the selective criteria like participants,interventions,comparisons and outcome measures.Two literatures were removed after reading the full text.Three literatures or four trials including 2668 patients were finally enrolled in this meta-analysis.The result indicated that,compared with placebo at week 12,topical formulations of minocycline significantly improved Investigator’s Global Assessment(IGA)success rate(RR=1.57,95%CI[1.34-1.85],P<0.001),reduced’inflammatory lesion count of acne’(WMD=3.40,95%CI[2.39-4.40],P<0.001)and’non-inflammatory lesion count of acne’(WMD=2.89,95%CI[1.23-4.55],P≤0.001),but TSA showed that more trials should be included to reevaluate the results of inflammatory and non-inflammatory lesions.Regarding safety aspects,the rate of treatment-related TEAE was lower in topical formulations compared with placebo without significant difference(RR=0.80,95%CI[0.54-1.19],P=0.278>0.05),so was the rate of participant discontinuation secondary to TEAE(RR=0.45,95%CI[0.19-1.06],P=0.07>0.05).Topical formulations of minocycline has lower rate of ’Skin peeling’(RR = 0.71,95%CI[0.46-1.11],P=0.14>0.05),’Dryness’(RR=0.79,95%CI[0.60-1.05],P=0.11>0.05)and ’Itching’(RR=0.90,95%CI[0.64-1.26],P=0.54>0.05),whereas has higher rate of ’Hyperpigmentation’(RR=1.26,95%CI[0.88-1.81],P=0.21>0.05);topical formulations of minocycline group reported almost same rate of‘Erythema’ to vehicle group(RR=0.97,95%CI[0.79-1.19],P=0.74>0.05);no significant difference was also observed between groups in above five facial local intolerability rates at week 12.ConclusionsTopical formulations of minocycline are effective,safe and well-tolerated medicines for moderate to severe acne.However,more high-quality,multi-center and large-scale randomized controlled trials are needed to prove it in the future. |
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