Background Rosacea treatments often lead to recurrence after discontinuation, highlighting the need for effective maintenance therapies. The long‐term efficacy of treatments in preventing relapse has not been systematically compared. Objectives To compare the risk of relapse upon treatment discontinuation after achieving clinical remission with both topical and systemic therapies. Methods Updated systematic review and network meta‐analysis of randomized controlled studies following PRISMA guidelines. A thorough literature search across different databases to identify randomized controlled trials (RCTs) on treatment relapse rates in adult patients with moderate to severe papulopustular rosacea treated with systemic and topical treatments was conducted. Data were independently extracted, and the risk of bias was assessed using the Cochrane tool. Statistical analyses were performed using network meta‐analysis with random effects models. Results A total of seven out of an initial 14,450 articles screened were retrieved, involving 632 patients with moderate to severe rosacea and 552 controls treated with metronidazole 0.75% gel, doxycycline 40 mg, ivermectin 1% cream, isotretinoin 0.25 mg/kg/day, hydroxychloroquine 200 mg, and aminolevulinic acid photodynamic therapy. Results showed that isotretinoin and metronidazole significantly prevented rosacea relapse compared to placebo, with isotretinoin ranked as the most effective treatment according to SUCRA rankings. The average time regarding relapse varied among studies, with metronidazole showing a shorter relapse period (12 weeks) than ivermectin (21 weeks). The risk of bias was low, with no significant publication bias detected. The limits of this review were the relatively small number of studies included and the high degree of indirectness that was noted across these studies, potentially affecting the reliability of some estimates. Conclusion Rosacea remission can be maintained for a certain period of time after the discontinuation of the treatment and also during the treatments. Isotretinoin might be effective in reducing the risk of relapse.
Trave et al. (Thu,) studied this question.