Meta-Analysis of 5% Imiquimod and 0.5% Podophyllotoxin in the Treatment of Condylomata Acuminata

ArticleinDermatology 213(3):218-23 · February 2006with49 Reads
DOI: 10.1159/000095039 · Source: PubMed
Genital warts are a common sexually transmitted disease caused by human papillomaviruses. Podophyllotoxin 0.5%, approved for patient self-administration, has been used most extensively in the treatment of genital warts. Imiquimod, a novel immune response modifier capable of inducing interferon-alpha and a variety of cytokines, has been examined as a potential treatment for genital warts. But 0.5% podophyllotoxin and 5% imiquimod have not been compared in any extensive and formal studies, although they are the common topical agents for genital warts. To evaluate the efficacy and safety of topical 5% imiquimod and 0.5% podophyllotoxin in the treatment of genital warts. We searched Medline (1966 to June 2005), Embase (1974 to June 2005) and the Cochrane Controlled Trials Register (issue 3, 2005). Randomized controlled trials of 5% imiquimod or 0.5% podophyllotoxin in the treatment of genital warts were collected. Two reviewers extracted the data and independently assessed the quality of the included medical literature. Then, meta-analysis was conducted. Twelve studies including 3 placebo-controlled trials of imiquimod and 9 placebo-controlled trials of podophyllotoxin were included. The clinical cure rates of imiquimod and podophyllotoxin were 50.34 and 56.41%, respectively, without statistically significant differences between the two (p > 0.05). A combined analysis of the 3 studies on imiquimod showed a statistically significant difference to the placebo group [pooled odds ratio (OR) 11.65, 95% confidence interval (CI) 6.05-22.44], as did a combined analysis of the 9 studies on podophyllotoxin (pooled OR 16.70, 95% CI 7.06-39.48). The most common adverse events of imiquimod were erythema, erosion, excoriation, itching and burning; those of podophyllotoxin were burning, pain, erosion, itching and inflammation. Imiquimod and podophyllotoxin possess similar curative effects on condylomata acuminata but podophyllotoxin has more serious adverse effects.
    • "Podophyllotoxin is a well-known plant secondary metabolite belonging to the aryltetralin lignan found in Podophyllum species [1,2] . According to the results of in vitro and in vivo studies , podophyllotoxin has many pharmacological effects, including immunomodulatory activity [3], antiviral action456 and antitumor action567. Furthermore, podophyllotoxin could be used as a lead compound for new pharmaceuticals; for example, the anticancer pharmaceuticals etoposide (VP-16) [8], teniposide (VM-26) [9] and etopophos [10,11]. "
    [Show abstract] [Hide abstract] ABSTRACT: A vacuum-powered bubble-assisted solvent extraction (VBE) technique was used to extract podophyllotoxin from the root of Sinopodophyllum emodi. We optimized the VBE procedure and showed it had the highest efficiency of extraction compared to other conventional extraction techniques. Based upon the results of single-factor experiments, a three-factor, three-level experiment design was developed by application of a Box-Behnken design. The method was validated by stability, repeatability and recovery experiments. The optimal conditions were: solvent, 60% (v/v) ethanol; particle size of the sample, 60-80 mesh; soak time, 2h; liquid/solid ratio, 21L/kg; air flow, 32mL/min; vacuum-powered bubble extraction time, 65min. The VBE method we developed achieved efficient extraction of podophyllotoxin from S. emodi. The podophyllotoxin extracted can be enriched and separated by an HPD300 macroporous resin adsorption and desorption process. The results indicated that VBE is a convenient, rapid and efficient sample preparation technique.
    Article · Sep 2015
    • "This cycle is repeated again every week until resolution of warts or a maximum of 4 weeks [40]. Side effects are minimal and include local erythema, swelling, mild pain, erosion, and pruritus [37,41]. Although podophyllotoxin is easily used at home, it is relatively expensive compared to other therapies [17]. "
    [Show abstract] [Hide abstract] ABSTRACT: Human papillomavirus (HPV) is the most common sexually transmitted disease. Via infection of the basal epithelial cells, HPV causes numerous malignancies and noncancerous cutaneous manifestations. Noncancerous cutaneous manifestations of HPV, including common, plantar, plane, and anogenital warts, are among the most common reasons for an office visit. Although there are various therapies available, they are notoriously difficult to treat. HPV treatments can be grouped into destructive (cantharidin, salicylic acid), virucidal (cidofovir, interferon-α), antimitotic (bleomycin, podophyllotoxin, 5-fluorouracil), immunotherapy (Candida antigen, contact allergen immunotherapy, imiquimod) or miscellaneous (trichloroacetic acid, polyphenon E). The mechanism of action, recent efficacy data, safety profile and recommended regimen for each of these treatment modalities is discussed.
    Full-text · Article · May 2015
    • "The published results with this treatment are very contradictory and vary from a complete lack of effect [10, 11, 13, 14, 17] to a reduction of the disease [12, 15, 16, 19, 35]. A recent meta-analysis unfortunately showed no superior effect of imiquimod (interferon í µí»¼) compared to podophyllotoxin in the treatment of CA [20] . Only few side effects of interferon are described in literature varying from miscellaneous reactions as fever, chills, headache, myalgia's, and leucocytosis to more severe and life threatening side effects as pericarditis, autoimmune disease and myelosuppression [16, 17, 19,363738. "
    [Show abstract] [Hide abstract] ABSTRACT: Giant condyloma acuminatum or Buschke-Lowenstein tumour is a very rare disease which usually is located in the genital, anorectal, and perianal regions. It is regarded as a type of verrucous carcinoma occurring on anogenital mucosal surfaces where it is locally invasive but displays a benign cytology. We describe a case of a 24-year-old woman with persisting condyloma acuminata progressing to a large intra-abdominal Buschke-Lowenstein tumour. To our knowledge such an advanced stage has only been reported once before. The severity and extent of the tumour both determine the treatment and patient outcome. Treatment was impeded by cachexia, an immunosuppressive state after kidney transplantation and difficulties in establishing a reliable diagnose. Interferon treatment was started which initially led to tumour reduction but was complicated by an interferon-induced pancreatitis, pneumonia, and fasciitis necroticans resulting in death. We present a literature overview on the treatment options for a Buschke-Lowenstein tumour, with emphasis on interferon therapy, with all the advantages and disadvantages.
    Full-text · Article · Sep 2013
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