Objectives: To compare the efficacy and safety of combination therapy with cryotherapy and podophyllotoxin 0.15% cream versus cryotherapy alone in the treatment of anogenital warts.
Methods: A randomised, double-blind, multi-centre controlled trial. Patients received podophyllotoxin cream or placebo twice daily for 3 days/week for up to 4 weeks, with weekly cryotherapy continued to week 12 if required. Further treatment from week 12-24 was discretionary. Patients were stratified by sex and history of warts. HIV-positivity, warts treated in the past 4 months, or warts with a combined area of <10mm2 were exclusion criteria. Primary endpoints were clearance at week 4 and 12.
Results: 70 patients per group were randomised and started treatment; 101 first-episode warts, 91 male. No treatment-related serious adverse events were reported. Follow-up at week 12 was 85%. By intention-to-treat analysis, clearances at 4 and 12 weeks were higher in the combination group (60.0% and 60.0% respectively) than with cryotherapy alone (45.7%, 45.7%) although not statistically significant (relative risk 1.31; 95% CI 0.95, 1.81). By week 24 there was no difference between the groups (68.6% and 64.3% respectively, RR 1.07; CI 0.84, 1.35). At week 4, wart clearance was higher in men (p=0.001) and those with a past history of warts (p=0.009), but these differences were not detected at week 12. There was some evidence for a higher relapse rate in the group receiving cryotherapy alone.
Conclusions: Initial combination therapy with podophyllotoxin/cryotherapy was well tolerated and may have resulted in earlier clearance in some patients, compared to cryotherapy alone, however overall differences in clearance rates were not statistically significant.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.