A systematic review 3 evaluated the clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts. 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by mixed-treatment comparison (MTC) indicated that ablative techniques were typically more effective than topical interventions at completely clearing warts at the end of treatment. Podophyllotoxin 0.5% solution 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. Podophyllotoxin 0.5% solution first line followed by carbon dioxide (CO2) laser therapy second line if warts 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.
A topic in Clinical Evidence 1 summarizes the results of 8 RCTs (n=1035) on podophyllotoxin. All found that, within 16 weeks of treatment, podophyllotoxin was more effective for clearance than placebo (RR values ranged between 2.0 and 48.0). There were 6 RCTs comparing podophyllotoxin and podophyllin. 5 RCTs found no difference, and 1 RCT found that self-treatment with podophyllotoxin solution, but not podophyllotoxin cream, was more effective than podophyllin applied at a clinic. Local inflammation, burning, and itching are reported as adverse effects in most trials.
In a randomized, open label trial 2 the effectiveness and safety of self-applied imiquimod 5% cream and podophyllotoxin 0.5% solution for anogenital warts were compared (n=45). The rates of clearance of baseline warts among treatment groups were 72% (95% CI 52%-86%) in the podophyllotoxin group and 75% (95% CI 53%-98%) in the imiquimod group. Statistically, clearance rates were identical (P=1). The differences in side effects between treatment groups were statistically not significant (P=0.24).
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