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Cryotherapy may be used as first-line therapy for anogenital warts

Cryotherapy did not differ in efficacy from other treatments for anogenital warts, and could be used as first-line therapy, according to recently published study results in the Journal of the American Academy of Dermatology.

Researchers in France conducted a systematic search of 12 electronic databases through Oct. 1, 2016, with search terms including anogenital wart, cryotherapy or randomized controlled trial. There were 1,281 references, from which 30 full-text articles were obtained and 11 randomized controlled trials included in the review.

Inclusion criteria included immunocompetent adults with anogenital warts receiving cryotherapy in one of the comparison groups. Complete clearance of anogenital warts was used as primary endpoint.

Cryotherapy was compared with trichloroacetic acid (four trials), podophyllin (three trials), imiquimod or electrosurgery (two trials each) and to CO₂ laser or 5% potassium hydroxide solution (one trial each). Efficacy did not appear to differ in cryotherapy compared with trichloroacetic acid, podophyllin or imiquimod.

There was a “weak association” between better anogenital wart clearance and electrosugery when compared with cryotherapy (RR = 0.8; 95% CI, 0.65-0.99).

Studies at high risk for bias included weak evidence suggesting there were more immediate low-level adverse events, including erythema, stinging or irritation, (RR = 3.02; 95% CI, 1.38-6.61) and pain that required oral analgesics (RR = 2.11; 95% CI, 1.07-4.17) when compared with other treatments. However, cryotherapy was less associated with minor bleeding, erosion or infection when compared with other treatments (RR = 0.57; 95% CI, 0.36-0.9).

“This systematic review with meta-analysis of cryotherapy efficacy and safety of patient with [anogenital warts] enable to us to conclude, with low-level quality of evidence, that no evidence supports cryotherapy superiority or inferiority when compared with [trichloroacetic acid], imiquimod, or podophyllin and that cryotherapy appears slightly less effective than electrosurgery,” the researchers wrote.

“The results of our analyses suggest that cryotherapy could be used as first-line therapy for [anogenital warts],” the researchers concluded. “Electrosurgery could be used but seems more aggressive (requiring local anesthesia), even though it is slightly more effective, and CO₂ laser could be used but is less available, particularly in developing countries.” – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.