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2024 recommendations for the therapeutic management of anogenital warts
1CHU La Réunion, Department of Infectious Diseases - Dermatology, Saint Pierre, La Réunion, France; UFR Santé (Health Training and Research Unit), University of La Réunion, France.
Introduction:
Anogenital warts (AGW) are benign epithelial skin lesions caused mainly by the human papillomavirus (HPV, types 6 and 11) but are sometimes associated with other oncogenic HPV types. They have a high rate of post-treatment recurrence. There are many guidelines, but they do not prioritise treatments. Therapeutics are classified as either self-administered or clinician applied. The aim of this study was to propose recommendations for the management of AGW.
Method:
These recommendations were based on a systematic review of the literature by a working group (WG) with no links of interest. The databases used were PubMed and Embase up to 1st June 2024. The risks of bias of the included studies were analysed using the PRISMA, ROBIS, AMSTAR 2, AGREE II, RIGHT and ROB grids. They were assessed by an expert review group using the GRaAL method of the French Health Authority (FHA).
Results:
A total of 204 studies were selected from 1446 (including randomised clinical trials (RCTs), systematic reviews (SR), non-randomised clinical trials involving more than 30 patients, meta-analyses (MA), and guidelines) by the working group (WG). The methodological quality of the studies varied widely. An algorithm proposing a hierarchy of treatments was developed for the general population, pregnant women, children, immunocompromised patients and for specific sites (urethral, vaginal and anal). Combination therapy has been widely adopted.
Conclusion:
Despite a lack of data on specific populations and variability in the quality of the studies analysed, these recommendations provide a hierarchy of treatments for AGW based on a systematic review of the literature.
Insights
This study provides treatment recommendations for anogenital warts (AGW) by establishing a hierarchy of therapies based on a systematic literature review. It addresses various patient groups and specific treatment sites, promoting combination therapy.
Area of Science:
- Dermatology
- Infectious Diseases
- Public Health
Background:
- Anogenital warts (AGW) are common skin lesions caused by human papillomavirus (HPV).
- AGW frequently recur after treatment, and existing guidelines lack treatment prioritization.
- Therapies for AGW are categorized as self-administered or clinician-applied.
Purpose of the Study:
- To develop evidence-based recommendations for managing anogenital warts (AGW).
- To establish a prioritized hierarchy of treatments for AGW.
- To provide guidance for diverse patient populations and specific anatomical sites.
Main Methods:
- A systematic literature review was conducted by a working group with no conflicts of interest.
- Databases searched included PubMed and Embase up to June 1, 2024.
- Study quality was assessed using multiple standardized tools (PRISMA, ROBIS, AMSTAR 2, AGREE II, RIGHT, ROB grids) and expert review (GRaAL method).
Main Results:
- 204 studies were selected from 1446, encompassing RCTs, SRs, non-randomized trials, MAs, and guidelines.
- Methodological quality of the included studies varied significantly.
- A treatment hierarchy algorithm was developed, considering general populations, pregnant women, children, immunocompromised individuals, and specific sites (urethral, vaginal, anal). Combination therapy is frequently recommended.
Conclusions:
- These recommendations offer a structured approach to AGW management.
- The hierarchy is based on a comprehensive systematic review of available literature.
- Acknowledges limitations due to data gaps in specific populations and study quality variations.
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