Intralesional Immunotherapy for the Treatment of Warts: A Network Meta-analysis

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Samar Salman, Mohamed Shehata Ahmed, Ahmed Mohamed Ibrahim, Omar Mohamed Mattar, Hassan El-Shirbiny, Sameh Sarsik, Ahmed M. Afifi, Ruba Marwan Anis, Nadim Aiman Yakoub Agha, Abdelrahman Ibrahim Abushouk

Abstract

Background

Without clear evidence, selecting among the existing immunotherapeutic options for warts remains challenging.

Objective

Through network meta-analyses, we aimed to evaluate the comparative efficacy of different intralesional immunotherapeutic modalities.

Methods

We included randomized controlled trials (RCTs) comparing intralesional immunotherapeutic modalities to cryotherapy, placebo or imiquimod. All outcomes were presented as odds ratio (OR) with 95% confidence-interval. Both conventional and network meta-analyses (with a frequentist approach) were conducted on R software. The P-score was used to rank different treatments.

Results

Network meta-analysis of 17 RCTs (1676 patients) showed that PPD (OR=39.56), MMR (OR=17.46) and INF-β (OR=15.55) had the highest efficacy in terms of complete recovery at the primary site, compared to placebo. Regarding complete recovery at the distant site, autoinoculation (OR=79.95), PPD (OR=42.95) and MMR (OR=15.39) were all statistically superior to placebo. According to the P-score, MMR was more effective than other modalities in reducing recurrence rate at the same site.

Limitations

Relatively-small sample size in some comparisons and variability in baseline characteristics.

Conclusion

PPD and MMR were the most effective in achieving complete primary and distant recovery (along with autoinoculation for distant recovery) and reducing the recurrence rate at the same site, compared to cryotherapy and other immunotherapeutic modalities.