Efficacy and safety of fractional CO2 laser combined with 308 nm excimer laser in non-segmental vitiligo: a meta-analysis with trial sequential analysis.

Objects: The study aimed to assess the effectiveness and safety of fractional CO₂ laser and 308 nm excimer laser in non-segmental vitiligo.

Materials and methods: We carried out a systematic literature search in databases: Embase, Web of Science, PubMed, Wanfang and CNKI. Randomized controlled trials (RCTs) comparing the combined treatment of fractional CO₂ and 308 nm excimer lasers with other treatments for non-segmental vitiligo were included. The primary outcomes were re-pigmentation rate and side effects.

Results: Twelve RCTs involving a total of 1,064 patients were included. Our results showed significantly higher rates of excellent response (≥75% re-pigmentation) (RR = 1.53, 95%CI: 1.31, 1.78; p < .001) and good response (50-75% re-pigmentation) (RR = 1.14, 95%CI: 1.03, 1.26; p = .015) in combined treatment group than the control group. A subgroup analysis considering control treatment suggested that, the combination treatment yielded a superior rate of excellent response when compared to either fractional CO₂ laser or 308 nm excimer laser. It also demonstrated a superior rate of good response compared to the fractional CO₂ laser, while showing a comparable effect to 308 nm excimer laser alone. Regarding safety, the adverse event rates were comparable between the two groups (RR = 0.67, 95%CI: 0.43, 1.07; p = .093). Meta-regression analysis indicated that none of these potential factors (mean age, gender, disease onset and vitiligo subtype) had any significant effect on excellent response rate. Results of trial sequential analysis (TSA) for excellent response rate suggested that current conclusions regarding combination treatment are adequate, and additional explorations are unlikely to alter the conclusion.

Conclusion: Our results suggested that, the combined treatment of fractional CO₂ and 308 nm excimer lasers seems to be an effective and well-tolerated modality for non-segmental vitiligo. It significantly improves the re-pigmentation rate without posing serious side effects. More high-quality, large-scale RCTs are warranted to further validate these results and explore the long-term efficacy and safety of this treatment approach.