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 - Funding Information:
This study was supported by grants from the “Allocation jeunes chercheurs hospitaliers” 2015 and the “Programme Hospitalier de Recherche Clinique Interrégional” (No. 13 069). The journal’s Rapid Service Fee was funded by the Department of Research and Innovation of the Centre Hospitalier Universitaire de La Réunion.
Funding Information:
We would like to thank Prof. Rodolphe Thiebaut for his continuous support, our research librarian Evelyne Mouillet, the dermatologists of the French Group of Dermato-Infectiology and Sexually Transmitted Diseases of the Soci?t? Fran?aise de Dermatologie and the Association des Dermatologues des Alpes du Sud , and our copy editor Arianne Dorval. This study was supported by grants from the ?Allocation jeunes chercheurs hospitaliers? 2015 and the ?Programme Hospitalier de Recherche Clinique Interr?gional? (No. 13 069). The journal?s Rapid Service Fee was funded by the Department of Research and Innovation of the Centre Hospitalier Universitaire de La R?union. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Christian Derancourt, Brigitte Milpied, and Nicolas Dupin conceptualized and designed the study. Antoine Bertolotti, Christian Derancourt, and Cyril Ferdynus participated in the acquisition, analysis, and interpretation of data. Antoine Bertolotti and Christian Derancourt drafted the initial manuscript. Laetitia Huiart, Nicolas Dupin, and Brigitte Milpied critically reviewed the manuscript. All authors read and approved the final manuscript. Antoine Bertolotti, Cyril Ferdynus, Brigitte Milpied, Nicolas Dupin, Laetitia Huiart and Christian Derancourt have nothing to disclose. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. The datasets analyzed during the current study are available from the corresponding author on reasonable request. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article?s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article?s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
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 - 2190-9172
VL - 10
SP - 249
EP - 262
JO - Dermatology and Therapy
JF - Dermatology and Therapy
IS - 2
ER -