Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction:No hierarchy of first-line treatments for anogenital warts (AGWs) is provided in international guidelines. This study aimed to determine the efficacy of topical treatments and ablative procedures for the management of AGWs. Methods: Twelve electronic databases were systematically searched from inception to August 2018. All randomized controlled trials (RCTs) comparing immunocompetent adults with AGWs who received at least 1 provideradministered or patient-administered treatment in at least 1 parallel group were included. Risk of bias assessment followed the Cochrane Handbook. The study endpoint was complete lesion response after clearance and recurrence assessment. A network meta-analysis was performed. Results: A network geometry was constructed based on 49 of the 70 RCTs included in our systematic review. All but 4 RCTs had a high risk of bias. The most efficacious treatments compared to placebo were surgery (RR 10.54; CI 95% 4.53-24.52), ablative therapy ? imiquimod (RR 7.52; CI 95% 4.53-24.52), and electrosurgery (RR 7.10; CI 95% 3. 47-14.53). SUCRA values confirmed the superiority of surgery (90.9%), ablative therapy ? imiquimod (79.8%), and Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11604663. Key Summary PointsWhy carry out this study?Anogenital warts (AGWs) are one of the most common sexually transmitted diseases, with an overall prevalence rate of around 1-5%.No clinically meaningful hierarchy of firstline treatments for anogenital warts is provided in international guidelines.What was learned from the study?Based on a low level of evidence, surgery and electrosurgery achieved the best complete lesion response after clearance and recurrence assessment.Podophyllotoxin 0.5% was the most efficacious patient-administered treatment.

A Multicentre, Randomised Clinical Trial to Compare a Topical Nitrizinc® Complex Solution Versus Cryotherapy for the Treatment of Anogenital Warts

“…The efficacy of NZCS has been described previously in five studies [ 8 – 11 , 17 ]. The first of these, published in 2015 by Cusini et al [ 17 ] showed that NZCS has an 87% efficacy in 30 patients after one to four applications [ 17 ].The second study, published by Rozas-Munoz et al in 2019 [ 10 ], involved 15 patients and reported an efficacy of 88.3% and no recurrence in the 3-month follow-up. The third study, by Ciccarese et al [ 8 ], also published in 2019, is one of the most interesting due to the number of patients treated (100), the number of AGW treated (418) and the length of follow-up (6 months).…”

“…In their recent meta-analyses on the effectiveness of treatments for AGW, Barton et al [ 15 ] conclude that laser CO 2 seems to be the most effective method but also that patient preference tends towards nonablative methods. Bertolotti et al [ 16 , 17 ] indicate electrosurgery and 0.5% podophyllotoxin as the most effective methods and recommend an randomised controlled trial on the combined therapies.…”

Repurposing Infectious Pathogen Vaccines in Cancer Immunotherapy

“…TLR7/8 natural agonists imiquimod and resiquimod have been used against basal cell carcinoma [34,35], melanoma, and other skin neoplasms [36] as well as against common warts [37,38]. Local imiquimod has also been used in combination with radiotherapy for breast cancer in the clinic [39].…”

Letter to the Editor Regarding ‘A Multicentre, Randomised Clinical Trial to Compare a Topical Nitrizinc® Complex Solution Versus Cryotherapy for the Treatment of Anogenital Warts’

“…Pontini et al evaluated AGW recurrence at 1 and 3 months [ 1 ]. However, given that AGW recurrence has been shown to be fairly common 6 months after treatment [ 9 – 11 ], they should also have done so at 6 and 12 months. Lastly, it should be noted that while ablative therapies (surgery, electrosurgery, CO 2 laser) are more effective than patient-administered treatments in the short term [ 4 , 9 ], the latter may be superior in the long term due to their immunomodulatory effects.…”