Imiquimod for anogenital warts in non-immunocompromised adults

30% of people with anogenital warts (AGW) have spontaneous regression of lesions but there is no way to determine whether a specific lesion will remain. There are a wide range of options available for treating people with AGW and selection is based on clinician's experience, patient preferences...

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Published in:Cochrane database of systematic reviews 2014-11, Vol.2014 (11), p.CD010389
Main Authors: Grillo-Ardila, Carlos F, Angel-Müller, Edith, Salazar-Díaz, Luis C, Gaitán, Hernando G, Ruiz-Parra, Ariel I, Lethaby, Anne
Format: Article
Language:English
Subjects:
Adult
Aminoquinolines - adverse effects
Aminoquinolines - therapeutic use
Anus Diseases - drug therapy
Anus Diseases - virology
Female
Genital Diseases, Female - drug therapy
Genital Diseases, Female - virology
Genital Diseases, Male - drug therapy
Genital Diseases, Male - virology
Gynaecology
Humans
Imiquimod
Immunocompetence
Infectious disease
Interferon Inducers - adverse effects
Interferon Inducers - therapeutic use
Keratolytic Agents - therapeutic use
Male
Podophyllin - therapeutic use
Podophyllotoxin - therapeutic use
Randomized Controlled Trials as Topic
Recurrence
Self Administration
Skin disorders
Treatment
Warts - drug therapy
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Summary:30% of people with anogenital warts (AGW) have spontaneous regression of lesions but there is no way to determine whether a specific lesion will remain. There are a wide range of options available for treating people with AGW and selection is based on clinician's experience, patient preferences and adverse effects. The imiquimod could offer the advantages of patient-applied therapies without incurring the limitations of provider-administered treatments. To assess the effectiveness and safety of imiquimod for the treatment of AGW in non-immunocompromised adults. We searched the Cochrane Sexually Transmitted Infections Group Specialized Register (15 April 2014), CENTRAL (1991 to 15 April 2014), MEDLINE (1946 to 15 April 2014), EMBASE (1947 to 15 April 2014), LILACS (1982 to 15 April 2014), World Health Organization International Clinical Trials Registry (ICTRP) (15 April 2014), ClinicalTrials.gov (15 April 2014), Web of Science (2001 to 15 April 2014) and OpenGrey (15 April 2014). We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. Randomized controlled trials (RCTs) comparing the use of imiquimod with placebo, any other patient-applied or any other provider-administered treatment (excluding interferon and 5-fluorouracil which are assessed in other Cochrane Reviews) for the treatment of AGW in non-immunocompromised adults. Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We resolved any disagreements through consensus. The quality of the evidence was assessed using the GRADE approach. Ten RCTs (1734 participants) met our inclusion criteria of which six were funded by industry. We judged the risk of bias of the included trials as high. Six trials (1294 participants) compared the use of imiquimod versus placebo. There was very low quality evidence that imiquimod was superior to placebo in achieving complete and partial regression (RR 4.03, 95% CI 2.03 to 7.99; RR 2.56, 95% CI 2.05 to 3.20, respectively). When compared with placebo, the effects of imiquimod on recurrence (RR 2.76, 95% CI 0.70 to 10.91), appearance of new warts (RR 0.76, 95% CI 0.58 to 1.00) and frequency of systemic adverse reactions (RR 0.91, 95% CI 0.63 to 1.32) were imprecise. We downgraded the quality of evidence to low or very low. There was low quality evidence that imiquimod led to more local adverse reactions (RR 1.73, 95% CI 1.18 to 2.53) and pain (RR 11.84
ISSN:1469-493X
DOI:10.1002/14651858.CD010389.pub2