Topical treatment of genital warts in men, an open study of podophyllotoxin cream compared with solution.

Strand, Anders; Brinkeborn, R.M.; Siboulet, A

doi:10.1136/sti.71.6.387

Cited by 29 publications

(31 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A prespecified sensitivity analysis included studies that (1) were deemed to be at high risk of bias, (2) enrolled people with AGWs who were seropositive for HIV infection and (3) were reported only as conference abstracts. The sensitivity analysis incorporated an additional 17 studies 63, 64,67,68,114,119,121,124,125,128,131,133,136,137,142,143,151 and provided information on four extra treatments. The networks of evidence are presented in Figure 3.…”

Section: Assessment Of Effectivenessmentioning

confidence: 99%

“…The probability of recurrence for all treatments is presented in Figure 11. Sensitivity analysis of recurrence at < 6 months included an additional six studies 64,67,136,137,142,151 and six other interventions: l podophyllotoxin 0.5% cream l podophyllotoxin 0.3% cream l podophyllotoxin 0.15% cream l podophyllin 0.5% solution (patient applied) l cryotherapy l electrotherapy.…”

Section: Recurrence At < 6 Monthsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation

Thurgar¹,

Barton²,

Karner³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundTypically occurring on the external genitalia, anogenital warts (AGWs) are benign epithelial skin lesions caused by human papillomavirus infection. AGWs are usually painless but can be unsightly and physically uncomfortable, and affected people might experience psychological distress. The evidence base on the clinical effectiveness and cost-effectiveness of treatments for AGWs is limited.ObjectivesTo systematically review the evidence on the clinical effectiveness of medical and surgical treatments for AGWs and to develop an economic model to estimate the cost-effectiveness of the treatments.Data sourcesElectronic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases and Web of Science) were searched from inception (or January 2000 for Web of Science) to September 2014. Bibliographies of relevant systematic reviews were hand-searched to identify potentially relevant studies. The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov were searched for ongoing and planned studies.Review methodsA systematic review of the clinical effectiveness literature was carried out according to standard methods and a mixed-treatment comparison (MTC) undertaken. The model implemented for each outcome was that with the lowest deviance information criterion. A de novo economic model was developed to assess cost-effectiveness from the perspective of the UK NHS. The model structure was informed through a systematic review of the economic literature and in consultation with clinical experts. Effectiveness data were obtained from the MTC. Costs were obtained from the literature and standard UK sources.ResultsOf 4232 titles and abstracts screened for inclusion in the review of clinical effectiveness, 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by MTC indicated that ablative techniques were typically more effective than topical interventions at completely clearing AGWs at the end of treatment. Podophyllotoxin 0.5% solution (Condyline®, Takeda Pharmaceutical Company Ltd; Warticon®solution, Stiefel Laboratories Ltd) was found to be the most effective topical treatment evaluated. Networks for other outcomes included fewer treatments, which restrict conclusions on the comparative effectiveness of interventions. In total, 84 treatment strategies were assessed using the economic model. Podophyllotoxin 0.5% solution first line followed by carbon dioxide (CO2) laser therapy second line if AGWs did not clear was most likely to be considered a cost-effective use of resources at a willingness to pay of £20,000–30,000 per additional quality-adjusted life-year gained. The result was robust to most sensitivity analyses conducted.LimitationsLimited reporting in identified studies of baseline characteristics for the enrolled population generates uncertainty around the comparability of the study populations and therefore the generalisability of the results to clinical practice. Subgroup analyses were planned based on type, number and size of AGWs, all of which are factors thought to influence treatment effect. Lack of data on clinical effectiveness based on these characteristics precluded analysis of the differential effects of treatments in the subgroups of interest. Despite identification of 60 studies, most comparisons in the MTC are informed by only one RCT. Additionally, lack of head-to-head RCTs comparing key treatments, together with minimal reporting of results in some studies, precluded comprehensive analysis of all treatments for AGWs.ConclusionsThe results generated by the MTC are in agreement with consensus opinion that ablative techniques are clinically more effective at completely clearing AGWs after treatment. However, the evidence base informing the MTC is limited. A head-to-head RCT that evaluates the comparative effectiveness of interventions used in clinical practice would help to discern the potential advantages and disadvantages of the individual treatments. The results of the economic analysis suggest that podophyllotoxin 0.5% solution is likely to represent a cost-effective first-line treatment option. More expensive effective treatments, such as CO2laser therapy or surgery, may represent cost-effective second-line treatment options. No treatment and podophyllin are unlikely to be considered cost-effective treatment options. There is uncertainty around the cost-effectiveness of treatment with imiquimod, trichloroacetic acid and cryotherapy.Study registrationThis study is registered as PROSPERO CRD42013005457.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Assessment Of Effectivenessmentioning

confidence: 99%

Section: Recurrence At < 6 Monthsmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation

Thurgar¹,

Barton²,

Karner³

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…32 Podophyllotoxin is preferred over podophyllum not only for its purity, stability, and lack of systemic toxicity, it has also been shown to have greater efficacy and cost effectiveness than clinic-based treatment with podophyllin (level IIB evidence), 33 with the added convenience of home therapy. [32][33][34][35][36][37][38] In a large randomized controlled trial, Lacey et al 33 found that podophyllotoxin solution and cream were three and two and a half times more likely, respectively, to produce cure than podophyllin. Reported clearance rates with podophyllotoxin solution or gel range Genital warts are diagnosed by a physical examination.…”

Section: Patient-applied Treatment Modalitiesmentioning

confidence: 97%

Human papillomavirus–related genital disease in the immunocompromised host

Gormley

Kovarik

2012

Journal of the American Academy of Dermatology

View full text Add to dashboard Cite

“…Vier RCTs belegten, dass bezüglich der Effektivität kein signifikanter Unterschied besteht [5,17,25,34]. Jedoch wurden in einer RCT mit der Lösung höhere Heilungsraten erzielt als mit der Creme [20] (EV-GR I).…”

Section: Em-gr Aunclassified

Leitlinie: Anale Feigwarzen

Wienert¹,

Breitkopf²,

Furtwängler³

et al. 2009

Coloproctol

View full text Add to dashboard Cite

Feigwarzen (Condylomata acuminata, spitze Kondylome) sind gutartige epitheliale Tumoren mit verschiedenen Ausprägungsformen. Je nach Lokalisation kön-nen sie als stecknadelkopfgroße, meist weißlich, braun oder rötlich pigmentierte Papeln sowohl solitär als auch multipel, beetartig konfluierend, aber auch als große blumenkohlartige Tumoren (destruierend: Buschke-Lö-wenstein-Tumor, nicht destruierend: Condylomata gigantea) imponieren. ÄtiopathogeneseKondylome sind virusinduziert. Sie enthalten meist die "low-risk" HPV-6-(humanes Papillomvirus) und HPV-11-DNA und andere, manchmal auch "high-risk" (onkogene) HPV-16-, -18-, -31-, -33-und -35-DNA und andere. Die Durchseuchung der sexuell aktiven Bevöl-kerung mit verschiedenen HPV-Typen ist hoch: 60% der Menschen tragen HPV-Antikörper in sich [16]. Bei Patienten mit Immunschwäche sind Kondylome häu-figer nachzuweisen. InfektionswegeDie Infektion erfolgt vorwiegend durch direkten Haut-zu-Haut-Kontakt und nicht durch Blutübertra-gung. Die Manifestation von Kondylomen im analen Bereich wird durch prädisponierende Faktoren wie Feuchtigkeit (Fluor), Mazeration (Ekzem) oder Epithelläsionen (Kratzeffekte, Analverkehr) begünstigt. Neben der vorwiegend sexuellen Übertragung sind in coloproctology

show abstract

Topical treatment of genital warts in men, an open study of podophyllotoxin cream compared with solution.

Cited by 29 publications

References 7 publications

Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation

Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation

Human papillomavirus–related genital disease in the immunocompromised host

Leitlinie: Anale Feigwarzen

Contact Info

Product

Resources

About