Systemic Interferon Gamma as Adjuvant Therapy for Refractory Anogenital Warts: A Randomized Clinical Trial and Meta-analysis of the Available Data

Zouboulis, Christos C.

doi:10.1001/archderm.1992.01680200125033

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Two trials (n=95) evaluated a placebo comparison of high-dose5 or low-dose11 gamma-IFN combined with ablative therapy. No significant differences were detected regarding long-term CC (1 RCT, RR 1.25, 95% CI 0.47 to 3.33, GRADE: moderate), intermediate-term recurrence (1 RCT, RR 1.20, 95% CI 0.54 to 2.67, GRADE: moderate) and long-term recurrence (1 RCT, RR 1.00, 95% CI 0.39 to 2.53, GRADE: moderate); these data refer to the low-dose regimen.…”

Section: Resultsmentioning

confidence: 99%

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Adjuvant treatment of anogenital warts with systemic interferon: a systematic review and meta-analysis

et al. 2017

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BackgroundInterferons are natural messenger proteins that are used to treat various disease entities. Due to their immunomodulating, antiviral and antiproliferative effects, the systemic administration of interferons after ablative treatment for anogenital warts (AGWs) has been advocated to increase clearance and decrease recurrence rates. However, studies investigating the efficacy of adjuvant systemic interferon have yielded inconsistent results. The objective of this systematic review and meta-analysis was to comprehensively assess and evaluate the available evidence from randomised controlled trials.MethodsA literature search was conducted in Cochrane Central Register of Controlled Trials, Embase and MEDLINE. Available data were classified according to the interferon type and dosage. Pooled effect estimates were calculated for predefined outcomes. The Cochrane Collaboration’s risk of bias tool was used to assess the included trials and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate our confidence in the effect estimates.ResultsTwelve trials were identified that met the inclusion criteria and assessed immunocompetent patients with external AGW. Compared with placebo, adjuvant alpha-, beta- and gamma-interferon were generally not significantly superior in terms of complete clearance over the short, intermediate or long term, nor with regard to intermediate- or long-term recurrence. However, the low-dose subgroup of adjuvant alpha-interferon was significantly superior compared with placebo regarding intermediate-term complete clearance and recurrence. Further data were available for the comparison of different dosages of alpha- and beta-interferon and for comparisons of the three interferon types. No significant differences were seen in these comparisons regarding efficacy. Data on quality of life were not available.ConclusionsThe GRADE quality of the evidence ranged from ‘very low’ to ‘high’. The significantly higher efficacy of low-dose alpha-interferon compared with placebo was based on a single trial, and our confidence in the effect estimates rated as ‘low’. Overall, we found no reliable evidence favouring the systemic use of interferon after ablative treatment of AGW.

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Section: Resultsmentioning

confidence: 99%

“…Only a single trial11 addressed solely recurrent AGW. Furthermore, the absence of eligible studies regarding immunocompromised patients, in whom these conditions occur more frequently, has to be seen as a limitation.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant treatment of anogenital warts with systemic interferon: a systematic review and meta-analysis

et al. 2017

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“…Recombinant IFN‐γ subcutaneously once a day (100 μg) for two separate 1‐week courses separated by a therapy‐free 3‐week interval failed to show response, supporting the finding that short‐term systemic IFN‐γ therapy is ineffective for condylomata. No major difference in cure rate was observed when surgical excision alone was compared to surgical excision and adjuvant recombinant IFN‐γ subcutaneously for 1 week (57).…”

Section: Treatment Of Warts: Physician Appliedmentioning

confidence: 93%

Treatment of warts

Berman

Weinstein

2000

Dermatol Ther

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Warts are caused by human papilloma viruses (HPV) and more than 80 types of HPV have been described. Although some HPV types in the anogenital area can lead to dysplasia and cancer, most HPV infections cause histologically benign warts. Clinically, warts produce much morbidity, mainly due to their resistance to most standard therapies. Although the choice of therapy depends partly on the location of the warts, i.e., anogenital vs. non‐anogenital, most treatments in the past have been anti‐wart but not antiviral. Therefore, removal of the wart was often followed by a recurrence in a few weeks due to sub‐clinical or latent HPV infections surrounding the wart. Such non‐antiviral therapies included a variety of acids, podophyllin, podophyllotoxin, chemotherapeutic agents, retinoids, topical sensitizers, a spectrum of surgical techniques, and cryotherapy. Two drugs approved for anogenital warts have antiviral and immunomodulatory activity, interferon and imiquimod, although imiquimod is much more convenient to use. While neither of these antiviral agents is approved for non‐anogenital warts, they do appear to have efficacy in these warts when used as adjunctive therapy. Experimental therapies for warts are currently under study and include topical cidofovir and both prophylactic and therapeutic HPV vaccines.

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Dermatologic Uses of Interferons

Berman

Sequeira

1995

Dermatologic Clinics

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Systemic Interferon Gamma as Adjuvant Therapy for Refractory Anogenital Warts: A Randomized Clinical Trial and Meta-analysis of the Available Data

Cited by 4 publications

References 8 publications

Adjuvant treatment of anogenital warts with systemic interferon: a systematic review and meta-analysis

Adjuvant treatment of anogenital warts with systemic interferon: a systematic review and meta-analysis

Treatment of warts

Dermatologic Uses of Interferons

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