Faculty of Medicine, Department of Dermatology and Venereology, Tanta University Hospital, Tanta University, Tanta, Egypt.
Faculty of Human Medicine, Zagazig University, Sharkia, Egypt.
Dermatol Ther. 2021 Mar;34(2):e14793. doi: 10.1111/dth.14793. Epub 2021 Feb 3.
The use of combined systemic retinoids and intralesional immunotherapy in the management of warts is still debatable without straightforward evidence. Through network meta-analysis, the current study evaluated the efficacy and safety of systemic retinoids alone or combined with other remedies in the treatment of warts. We searched six literature databases for clinical trials that compared systemic retinoids to local treatments or placebo in wart management. Outcomes were calculated as odds ratios (OR) with 95% confidence-interval. We used the R software to perform conventional and network meta-analyses (with a frequentist approach). Network meta-analysis of eight trials showed that oral acitretin plus intralesional Candida Ag (OR = 367.71), INF-α plus oral isotretinoin (OR = 223.77), oral acitretin (OR = 117), Candida Ag (OR = 91.93), oral isotretinoin (OR = 62.26) and topical isotretinoin (OR = 17.69) had higher complete recovery rates than placebo. Regarding the P-score, oral acitretin plus intralesional Candida Ag had the highest efficacy in achieving complete response (P-score = 0.88), followed by INF-α plus oral isotretinoin (P-score = 0.79), then oral acitretin (P-score = 0.60). Variable baseline characteristics and lack of data on some outcomes. The current study shows the efficacy for systemic retinoids in the treatment of warts, especially reluctant or recurrent types. Moreover, combinations of systemic retinoids with intralesional immunotherapy yield higher rates of complete clearance with lower recurrence.
联合全身用维 A 酸类药物和皮损内免疫治疗用于疣的治疗仍存在争议，尚无直接证据。本研究通过网状 Meta 分析，评估了全身用维 A 酸类药物单独或联合其他治疗方法治疗疣的疗效和安全性。我们检索了 6 个文献数据库，以纳入比较全身用维 A 酸类药物与局部治疗或安慰剂治疗疣的临床试验。结局指标采用比值比（OR）及其 95%置信区间（CI）表示。采用 R 软件进行常规 Meta 分析和网状 Meta 分析（采用频率学派方法）。8 项试验的网状 Meta 分析结果显示，口服阿维 A 联合皮损内注射白色念珠菌抗原（OR = 367.71）、IFN-α 联合口服异维 A 酸（OR = 223.77）、口服阿维 A（OR = 117）、白色念珠菌抗原（OR = 91.93）、口服异维 A 酸（OR = 62.26）和外用异维 A 酸（OR = 17.69）的完全缓解率均高于安慰剂。P 评分方面，口服阿维 A 联合皮损内注射白色念珠菌抗原的疗效最高（P 评分 = 0.88），其次为 IFN-α 联合口服异维 A 酸（P 评分 = 0.79），然后是口服阿维 A（P 评分 = 0.60）。存在基线特征的变异性和部分结局数据缺失。本研究显示全身用维 A 酸类药物治疗疣，尤其是难治性或复发性疣，具有一定疗效。此外，全身用维 A 酸类药物联合皮损内免疫治疗可提高完全清除率，降低复发率。
