TY - JOUR
T1 - Local Management of Anogenital Warts in Non-Immunocompromised Adults
T2 - A Network Meta-Analysis of Randomized Controlled Trials
AU - Bertolotti, Antoine
AU - Ferdynus, Cyril
AU - Milpied, Brigitte
AU - Dupin, Nicolas
AU - Huiart, Laetitia
AU - Derancourt, Christian
N1 - Publisher Copyright:
© 2020, The Author(s).
PY - 2020/4/1
Y1 - 2020/4/1
N2 - 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 provider-administered 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 electrosurgery (77.1%). The most efficacious patient-administered treatments were podophyllotoxin 0.5% solution (63.5%) and podophyllotoxin 0.5% cream (62.2%). Conclusions: With low-level evidence of most included RCTs, surgery and electrosurgery were superior to other treatments after clearance and recurrence assessment. Podophyllotoxin 0.5% was the most efficacious patient-administered treatment. Combined therapies should be evaluated in future RCTs in view of their identified effectiveness. The results of future RCTs should systematically include clinical type, number and location of AGWs, and sex of the patient, to refine therapeutic indications. Protocol Registration: PROSPERO-CRD42015025827.
AB - 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 provider-administered 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 electrosurgery (77.1%). The most efficacious patient-administered treatments were podophyllotoxin 0.5% solution (63.5%) and podophyllotoxin 0.5% cream (62.2%). Conclusions: With low-level evidence of most included RCTs, surgery and electrosurgery were superior to other treatments after clearance and recurrence assessment. Podophyllotoxin 0.5% was the most efficacious patient-administered treatment. Combined therapies should be evaluated in future RCTs in view of their identified effectiveness. The results of future RCTs should systematically include clinical type, number and location of AGWs, and sex of the patient, to refine therapeutic indications. Protocol Registration: PROSPERO-CRD42015025827.
KW - Anogenital warts
KW - Condyloma
KW - Frequentist approach
KW - Network meta-analysis
KW - Sexually transmitted disease
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85079149506&partnerID=8YFLogxK
U2 - 10.1007/s13555-020-00357-z
DO - 10.1007/s13555-020-00357-z
M3 - Article
AN - SCOPUS:85079149506
SN - 2193-8210
VL - 10
SP - 249
EP - 262
JO - Dermatology and Therapy
JF - Dermatology and Therapy
IS - 2
ER -