Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials

Abstract

Many topical treatments for cutaneous warts exist and previous reviews of trials did not follow intention-to-treat (ITT) principles for analysis. We aimed to perform a meta-analysis and pooled analysis of randomized controlled trials (RCTs) of topical treatment for cutaneous warts using ITT principles. Systematic electronic searches (Cochrane library, Medline, Embase, Clinical trial registers) were conducted in May 2009. Included trials reported completed cure of warts and data were extracted from these trials. We performed random-effects meta-analysis and assessed heterogeneity using the I(2) statistic and conducted a pooled analysis of each treatment. We found 77 relevant studies of which the majority were of low methodological quality. Salicylic acid (SA) was superior to placebo with a risk ratio (RR) for cure of 1·60 [95% confidence interval (CI) 1·15-2·24]. Cryotherapy was not statistically better than placebo, RR 0·89 (95% CI 0·27-2·92), but aggressive cryotherapy was significantly better than gentle cryotherapy with a RR of 2·06 (95% 1·20-3·52). Combined therapy of SA and cryotherapy had a higher cure rate than either SA or cryotherapy alone. The results of the pooled analysis found a cure rate of 23% (5-73%) in placebo trials, 52% (0-87%) in SA trials, 49% (0-69%) in cryotherapy trials, 54% (45-75%) in aggressive cryotherapy trials and 58% (38-78%) in the combined cryotherapy and SA trials. Aside from the use of SA and aggressive cryotherapy there is insufficient evidence from RCTs to support the use of other therapies. Higher quality evidence is needed to evaluate other therapies.

Intra-arterial vasodilators to prevent radial artery spasm: a systematic review and pooled analysis of clinical studies

“…The data collected was on the year, country, number of participants, age of participants, % of male participants, participant inclusion criteria, and type of treatments, efficacy outcomes and safety outcomes. These results were narratively synthesized and trials with similar treatment arms were pooled using methods previous described [11].…”

British Association of Dermatologists' guidelines for the management of cutaneous warts 2014

“…In contrast, placebo had a cure rate of 23% (range 5-73%). 10 Two important trials published within the last few years 11,12 are included in a recently updated Cochrane review. 13 Bruggink et al 11 studied 250 patients in primary care who were randomized to one of three treatment regimens: SA 40% ointment, fortnightly cotton-bud cryotherapy, or no treatment for 13 weeks.…”

“…10 Where possible, subgroup analysis of data from these trials suggests that cure rates are generally better for hand warts than for plantar warts. Two recently published trials 11,12 have provided much betterquality data than previously and have compared cryotherapy directly with SA.…”

“…Combination treatments can be undertaken 10,17,20,21 Other treatments: dithranol, 87 5-FU, 93 formaldehyde, 78 glutaraldehyde, 35 hyperthermia, 55 laser, 58,65 PDT, 68,73 podophyllotoxin, 90 topical immunotherapy 133,136 Plane warts On the backs of the hands or face, plane warts are mainly a cosmetic problem and spontaneous clearance can often be awaited. Destructive and caustic agents are more likely to produce scarring at these sites and should be used with care Salicylic acid cream/ointment 2-10% or cautious use of salicylic acid paint, 12-17%, used without occlusion Cryotherapy, milder freeze Topical retinoid 110,111 Others treatments: acupuncture, 171 cantharidin, 41 for the most part, weak.…”

The comparison study of 5 Fluorouracil vs. cryotherpy in the treatment of the backhand resistant common wart

“…They are indeed benign prolife ration of skin and mucous [1][2][3][4][5]. This disease is relatively common and it caused by a group of viruses called ''human papilloma virus'', that can grow on the skin, the inner surface of the mouth and genital and anal areas [6,7]. According to importance of performance, availability and cost of selected method in tearing patients with ''hand warts'', and also the lack of relevant studies about this case (8,9), we decided to compare''5-fluorouracil therapy'' with ''cryotherapy'' in treatment of common warts on hands, if there is one superior to the other methods, we use it as the preferred treatment method.…”