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Systematic Review of Imiquimod for the Treatment of External Genital Wart Publisher



Jaffary F1, 2, 3 ; Musini V3 ; Nilforoushzadeh MA2 ; Bassett K3
Authors
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Authors Affiliations
  1. 1. Department of Pharmacology, School of Pharmacy, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran
  2. 2. Skin Disease and Leishmaniasis Research Center, Isfahan University of Medical Sciences and Health Services, Sedigheh Tehareh Research Center, Isfahan, Iran
  3. 3. Therapeutics Initiative, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC V6T 1Z3, 2176 Health Sciences Mall, Canada

Source: International Journal of Pharmacology Published:2007


Abstract

The objective of this review is to assess whether imiquimod provides a therapeutic advantage over placebo (vehicle) or other active therapy used in the treatment of adult patients with external genital and perianal warts/condyloma acuminata. We searched MEDLINE (1966 -March 2006), EMBASE (1988-March 2006) and the Cochrane database for randomized controlled trials. Eight RCTs were identified that met the inclusion criteria. None of them compared imiquimod to other active therapy. Seven trials compared imiquimod (1, 2 or 5% cream) to placebo in immunocompetent patients of which only two trials used the recommended dose and dosing regimen with a follow up of 12 weeks duration. Mortality and serious adverse events were not reported. The effectiveness of imiquimod over other existing therapies for the treatment of external genital/perianal warts has not been established. In immunocompetent patients, there is sufficient evidence to conclude that imiquimod 5% cream applied three times a week for a maximum duration of 16 weeks compared to placebo provides a short term efficacy advantage in terms of complete clearance with no recurrence at the end of 12 weeks of follow up (ARR = 27%, NNT = 4). There were significant increases in several adverse events (erythema ARI = 43%, NNH = 2; erosion ARI = 24%, NNH = 4; excoriation ARI = 22%, NNH = 5; edema ARI = 15%, NNH = 7; scabbing ARI = 13%, NNH = 8 and induration ARI = 6%, NNH = 17). Based on one trial in immunocompromised patients (HIV positive) we conclude that there is insufficient evidence that imiquimod provides a therapeutic advantage compared to placebo. © 2007 Asian Network for Scientific Information.