Samar Salman1, Mohamed Shehata Ahmed2, Ahmed Mohamed Ibrahim3, Omar Mohamed Mattar4, Hassan El-Shirbiny5, Sameh Sarsik6, Ahmed M Afifi7, Ruba Marwan Anis4, Nadim Aiman Yakoub Agha4, Abdelrahman Ibrahim Abushouk8. 1. Department of Dermatology and Venereology, Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt; Medical Research, Education, and Practice Association, Egypt. 2. Faculty of Human Medicine, Zagazig University, Zagazig, Egypt. 3. Medical Research, Education, and Practice Association, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt. 4. Medical Research, Education, and Practice Association, Egypt; Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt. 5. Medical Research, Education, and Practice Association, Egypt; Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt. 6. Department of Dermatology and Venereology, Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt. 7. Faculty of Medicine, Ain Shams University, Cairo, Egypt. 8. Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: abdelrahman.abushouk@med.asu.edu.eg.
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 comparing intralesional immunotherapeutic modalities to cryotherapy, placebo, or imiquimod. All outcomes were presented as odds ratios (ORs) with 95% confidence intervals. 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 randomized controlled trials (1676 patients) showed that PPD (purified protein derivative vaccine, OR 39.56), MMR (measles, mumps, rubella vaccine, OR 17.46) and interferon β (OR 15.55) had the highest efficacy in terms of complete recovery at the primary site compared with 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 the 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 with cryotherapy and other immunotherapeutic modalities.
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 comparing intralesional immunotherapeutic modalities to cryotherapy, placebo, or imiquimod. All outcomes were presented as odds ratios (ORs) with 95% confidence intervals. 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 randomized controlled trials (1676 patients) showed that PPD (purified protein derivative vaccine, OR 39.56), MMR (measles, mumps, rubella vaccine, OR 17.46) and interferon β (OR 15.55) had the highest efficacy in terms of complete recovery at the primary site compared with 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 the 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 with cryotherapy and other immunotherapeutic modalities.
Authors: Gamal El-Din A Abuo-Rahma; Mamdouh F A Mohamed; Tarek S Ibrahim; Mai E Shoman; Ebtihal Samir; Rehab M Abd El-Baky Journal: RSC Adv Date: 2020-07-17 Impact factor: 4.036