Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany.
Sex Transm Infect. 2018 Feb;94(1):21-29. doi: 10.1136/sextrans-2017-053150. Epub 2017 Aug 17.
Interferons are natural messenger proteins that are used to treat various disease entities. Due to their immunomodulating, antiviral and antiproliferative effects, the systemic administration of interferons after ablative treatment for anogenital warts (AGWs) has been advocated to increase clearance and decrease recurrence rates. However, studies investigating the efficacy of adjuvant systemic interferon have yielded inconsistent results. The objective of this systematic review and meta-analysis was to comprehensively assess and evaluate the available evidence from randomised controlled trials.
A literature search was conducted in Cochrane Central Register of Controlled Trials, Embase and MEDLINE. Available data were classified according to the interferon type and dosage. Pooled effect estimates were calculated for predefined outcomes. The Cochrane Collaboration's risk of bias tool was used to assess the included trials and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate our confidence in the effect estimates.
Twelve trials were identified that met the inclusion criteria and assessed immunocompetent patients with external AGW. Compared with placebo, adjuvant alpha-, beta- and gamma-interferon were generally not significantly superior in terms of complete clearance over the short, intermediate or long term, nor with regard to intermediate- or long-term recurrence. However, the low-dose subgroup of adjuvant alpha-interferon was significantly superior compared with placebo regarding intermediate-term complete clearance and recurrence. Further data were available for the comparison of different dosages of alpha- and beta-interferon and for comparisons of the three interferon types. No significant differences were seen in these comparisons regarding efficacy. Data on quality of life were not available.
The GRADE quality of the evidence ranged from 'very low' to 'high'. The significantly higher efficacy of low-dose alpha-interferon compared with placebo was based on a single trial, and our confidence in the effect estimates rated as 'low'. Overall, we found no reliable evidence favouring the systemic use of interferon after ablative treatment of AGW.
干扰素是天然的信使蛋白，用于治疗各种疾病实体。由于其免疫调节、抗病毒和抗增殖作用，在消融治疗肛门生殖器疣（AGW）后全身给予干扰素已被提倡用于增加清除率和降低复发率。然而，研究全身辅助干扰素的疗效的研究结果不一致。本系统评价和荟萃分析的目的是全面评估和评估随机对照试验的现有证据。
在 Cochrane 对照试验中央注册库、Embase 和 MEDLINE 中进行文献检索。根据干扰素类型和剂量对可用数据进行分类。为预设结局计算汇总效应估计值。使用 Cochrane 协作风险偏倚工具评估纳入的试验，并使用推荐评估、制定和评估（GRADE）方法评估我们对效应估计值的信心。
确定了 12 项符合纳入标准的试验，评估了免疫功能正常的外部 AGW 患者。与安慰剂相比，辅助α-、β-和γ-干扰素在短期内、中期或长期完全清除方面通常没有显著优势，也没有在中期或长期复发方面具有优势。然而，辅助α-干扰素的低剂量亚组在中期完全清除和复发方面与安慰剂相比具有显著优势。对于辅助α-和β-干扰素不同剂量的比较以及三种干扰素类型的比较，有进一步的数据。在这些比较中，疗效没有差异。没有关于生活质量的数据。
证据的 GRADE 质量等级为“非常低”至“高”。与安慰剂相比，低剂量α-干扰素的疗效显著更高，这是基于一项单一试验，我们对效应估计值的信心评为“低”。总体而言，我们没有发现可靠的证据支持在消融治疗 AGW 后全身使用干扰素。
