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

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 searc...

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Autores principales: Bertolotti, Antoine, Ferdynus, Cyril, Milpied, Brigitte, Dupin, Nicolas, Huiart, Laetitia, Derancourt, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090115/
https://www.ncbi.nlm.nih.gov/pubmed/32030564
http://dx.doi.org/10.1007/s13555-020-00357-z
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author Bertolotti, Antoine
Ferdynus, Cyril
Milpied, Brigitte
Dupin, Nicolas
Huiart, Laetitia
Derancourt, Christian
author_facet Bertolotti, Antoine
Ferdynus, Cyril
Milpied, Brigitte
Dupin, Nicolas
Huiart, Laetitia
Derancourt, Christian
author_sort Bertolotti, Antoine
collection PubMed
description 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 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13555-020-00357-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-70901152020-03-27 Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials Bertolotti, Antoine Ferdynus, Cyril Milpied, Brigitte Dupin, Nicolas Huiart, Laetitia Derancourt, Christian Dermatol Ther (Heidelb) Original Research 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 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13555-020-00357-z) contains supplementary material, which is available to authorized users. Springer Healthcare 2020-02-06 /pmc/articles/PMC7090115/ /pubmed/32030564 http://dx.doi.org/10.1007/s13555-020-00357-z Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/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/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Bertolotti, Antoine
Ferdynus, Cyril
Milpied, Brigitte
Dupin, Nicolas
Huiart, Laetitia
Derancourt, Christian
Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials
title Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials
title_full Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials
title_fullStr Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials
title_short Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials
title_sort local management of anogenital warts in non-immunocompromised adults: a network meta-analysis of randomized controlled trials
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090115/
https://www.ncbi.nlm.nih.gov/pubmed/32030564
http://dx.doi.org/10.1007/s13555-020-00357-z
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