Topical preparations for the treatment of mild‐to‐moderate acne vulgaris: systematic review and network meta‐analysis*

Background Acne is very common and can have a substantial impact on wellbeing. Guidelines suggest first-line management with topical treatments, but there little evidence regarding which treatments are most effective. Objectives To identify the effective best tolerated for acne using network meta-analysis. Methods CENTRAL, MEDLINE, Embase World Health Organization Trials Registry were searched from inception to June 2020 randomized trials that included participants mild/moderate acne. Primary outcomes self-reported improvement in acne, trial withdrawal. Secondary change lesion counts, Investigator’s Global Assessment, quality of life total number adverse events. Network meta-analysis was undertaken frequentist approach. Risk bias assessed Cochrane Bias Tool confidence CINeMA. Results A 81 papers included, reporting 40 18 089 participants. Patient Assessment Improvement reported 11 trials. Based pooled estimates, compared vehicle, benzoyl peroxide (BPO) (35% vs. 26%) improving The combinations BPO adapalene (54% 35%) or clindamycin (49% ranked more than alone. withdrawal 35 patients withdrawing owing events low all treatments. Rates slightly higher (2·5%) (2·7%) (1·6%) alone (1·0%). Overall low. Conclusions Adapalene combination may be treatment incidence monotherapy. Inconsistent results precluded firmer conclusions.