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Abstract
Daylight photodynamic therapy (dPDT) is suggested to be effective for actinic keratosis
(AK). We performed a meta-analysis of randomized controlled trials (RCTs) to compare
the efficacy and safety of dPDT versus conventional photodynamic therapy (cPDT) in
patients with AK. Relevant studies were identified through a systematic search of
PubMed, Embase, and the Cochrane Library. A fixed or random effect model was applied,
depending on the heterogeneity. Six RCTs with 369 patients with 5,556 AK lesions that
were undergoing dPDT or cPDT with red light and methyl aminolevulinate (MAL) were
included. Overall, the incidence of complete response (CR) was not significantly different
between the two groups (risk ratio [RR]: 0.93, p = 0.07). Subgroup analyses indicated
that dPDT was non-inferior to cPDT for CR in studies only included grade III AK lesions
(RR: 0.97, p = 0.41), but less effective for CR in studies which also included grade
III lesions (RR = 0.87, p < 0.001). Subsequent meta-analyses showed that dPDT was
associated with a significantly reduced maximal pain score (mean difference = -4.51,
p < 0.001) and a lower risk of adverse events (RR = 0.70, p < 0.001) as compared with
cPDT. These results suggested although dPDT was better tolerated, the treatment efficacy
of dPDT is non-inferior to cPDT with red light and MAL only in grade III AK lesions.
The relative therapeutic efficacy of dPDT in AK of grade III lesions in comparison
with cPDT should be further evaluated.