Risk of Relapse Upon Treatment Discontinuation in Rosacea: An Updated Systematic Review and Network Meta‐Analysis of Randomized Controlled Trials

Background: Rosacea treatments often lead to recurrence after discontinuation, highlighting the need for efective maintenancetherapies. Te long-term efcacy 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 andsystemic therapies.Methods: Updated systematic review and network meta-analysis of randomized controlled studies following PRISMA guidelines.A thorough literature search across diferent databases to identify randomized controlled trials (RCTs) on treatment relapse ratesin 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 performedusing network meta-analysis with random efects models.Results: A total of seven out of an initial 14,450 articles screened were retrieved, involving 632 patients with moderate to severerosacea and 552 controls treated with metronidazole 0.75% gel, doxycycline 40 mg, ivermectin 1% cream, isotretinoin0.25 mg/kg/day, hydroxychloroquine 200 mg, and aminolevulinic acid photodynamic therapy. Results showed that isotretinoinand metronidazole signifcantly prevented rosacea relapse compared to placebo, with isotretinoin ranked as the most efectivetreatment according to SUCRA rankings. Te average time regarding relapse varied among studies, with metronidazole showinga shorter relapse period (12 weeks) than ivermectin (21 weeks). Te risk of bias was low, with no signifcant publication biasdetected. Te limits of this review were the relatively small number of studies included and the high degree of indirectness that wasnoted across these studies, potentially afecting the reliability of some estimates.Conclusion: Rosacea remission can be maintained for a certain period of time after the discontinuation of the treatment and alsoduring the treatments. Isotretinoin might be efective in reducing the risk of relapse