<p>Intergovernmental targets are reinforcing the need for more sustainable fisheries and more effective marine conservation. It is now urgent to understand how area-based conservation and sustainable fisheries management tools contribute to these environmental and socio-economic goals. Here, we systematically reviewed and assessed the outcomes of marine protected areas (accounting for their level of protection and of enforcement), fisheries restricted areas, and fishing effort reduction measures in the Mediterranean Sea, using 11 ecological and economic indicators. We show that commercial species in general, and fish species in particular, showed the highest proportion of positive to neutral effects in response to the management tools assessed compared to non-commercial and benthic assemblages. Among the management tools, partially protected areas showed the lowest proportion of positive to neutral effects compared to fully protected areas, and to the other management tools. Partially protected areas and fully protected areas showed higher neutral to negative ratio than fishing effort reduction measures overall. Within MPA protection levels with high enforcement, fully protected areas outperformed minimally protected areas, based on the higher positive to neutral effects ratio. Our results further underscored the critical role of enforcement, particularly for fully protected areas, which were found more beneficial overall under high enforcement than medium enforcement (based on positive to neutral effects ratio). Our findings support the prioritisation of well enforced fully protected areas and the integration of fisheries management and conservation objectives in marine spatial planning to effectively achieve regional and global sustainability goals for the ocean.</p>