Background: Combination therapies are increasingly recognized in keloid management, which has been challenging due to high recurrence and variable individual responses. This Network Meta-Analysis (NMA) aimed to identify the most effective combinations with the lowest recurrence rates. Methods: The protocol was registered in PROSPERO (CRD42024594922). Relevant Randomized Controlled Trials (RCT) evaluating all combination therapies for keloid were extracted from Cochrane, PubMed, and Scopus, until January 7, 2025. Results: A total of 1398 cases from 22 RCTs comparing different treatment combinations for keloid were included. The NMA revealed that only combinations involving Triamcinolone Acetonide (TAC) and 5-Fluorouracil (5-FU) displayed significantly higher efficacy than TAC monotherapy: TAC + 5-FU + Pulsed Dye Laser (PDL) (RR 2.98; 95% CI: 1.26 to 7.02) and TAC + 5-FU (RR 1.43; 95% CI: 1.05 to 1.93). The lowest recurrence rates were found in TAC + bleomycin (RR 0.04; 95% CI: 0.00 to 0.84) and TAC + 5-FU + brachytherapy (RR 0.23; 95% CI: 0.07 to 0.73). No other combinations showed statistically significant differences. Funnel plot analysis revealed no publication bias. Conclusions: Combination therapies, particularly TAC + 5-FU with PDL or brachytherapy, and TAC + bleomycin, outperform TAC alone in efficacy and recurrence reduction. These findings support tailored, multimodal approaches for optimal keloid management and improved patient outcomes.
Chandra et al. (Fri,) studied this question.
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