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Abstract
Objective To generate estimates of comparative clinical effectiveness for interventions used in the treatment of anogenital warts (AGWs) through the systematic review, appraisal and synthesis of data from randomised controlled trials (RCTs).
Design Systematic review and network meta-analysis of RCTs. Search strategies were developed for MEDLINE, Embase, the Cochrane Library and the Web of Science. For electronic databases, searches were run from inception to March 2018. The systematic review was carried out following the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Participants People aged ≥16 years with clinically diagnosed AGWs (irrespective of biopsy confirmation).
Interventions Topical and ablative treatments recommended by the British Association for Sexual Health and HIV for the treatment of AGWs, either as monotherapy or in combination versus each other.
Outcome measures Complete clearance of AGWs at the end of treatment and at other scheduled visits, and rate of recurrence.
Results Thirty-seven RCTs met inclusion criteria. Twenty studies were assessed as being at unclear risk of bias, with the remaining studies categorised as high risk of bias. Network meta-analysis indicates that, of the treatment options compared, carbon dioxide laser therapy is the most effective treatment for achieving complete clearance of AGWs at the end of treatment. Of patient-applied topical treatments, podophyllotoxin 0.5% solution was found to be the most effective at achieving complete clearance, and was associated with a statistically significant difference compared with imiquimod 5% cream and polyphenon E 10% ointment (p<0.05). Few data were available on recurrence of AGWs after complete clearance. Of the interventions evaluated, surgical excision was the most effective at minimising risk of recurrence.
Conclusion Of the studies assessed, as a collective, the quality of the evidence is low. Few studies are available that evaluate treatment options versus each other.
Trial registration number CRD42013005457
- anogenital warts
- condylomata acuminata
- meta-analysis
- systematic review
- treatment
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Footnotes
Contributors SB and VW reviewed titles and abstracts for inclusion into the review. SB and VW evaluated full publications for inclusion in the review. VW carried out the network meta-analyses, which was validated by SE. SB and VW contributed equally to the drafting of this article. COM contributed clinical expertise throughout the project. SE and COM edited and commented on draft reports and read the final article.
Funding The review reported here is an update and extension to independent research funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (HTA 12/44). The views and opinions expressed in this report are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.