D A Lucero Calvache, L C Peláez Vélez, C L Maldonado Carrasco, E Loayza
In patients with common warts, intralesional bleomycin may be associated with higher short-term clearance than cryotherapy. However, these short-term findings are based on a very small number of heterogeneous randomized controlled trials with follow-up of up to 12 weeks, and recurrence and long-term cure could not be assessed. The certainty of the evidence is therefore low, and the results should be interpreted with great caution. In clinical practice, any potential gain in short-term clearance with intralesional bleomycin needs to be weighed against its greater procedure-related pain and local adverse events, as well as factors such as accessibility, clinical expertise, and individual patient preferences.
BACKGROUND: Cryotherapy is a well-established treatment for common warts. However, the efficacy of bleomycin in the treatment of this condition is less well established. Therefore, we conducted a meta-analysis to compare the efficacy of bleomycin versus cryotherapy for the treatment of common warts.
METHODS: PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials that compared bleomycin with cryotherapy for the management of common warts and reported the outcomes of (1) lack of complete clinical clearance at the patient level (patients with at least 1 residual wart at the end of follow-up) and (2) proportion of warts not completely cleared at the lesion level. Heterogeneity was examined using the I² statistic. A random-effects model was used for outcomes with high heterogeneity.
RESULTS: We included 4 randomized controlled trials (RCTs) with 489 patients, of whom 247 (50.2%) received bleomycin. Follow-up intervals ranged from 2 to 3 weeks, with a maximum follow-up of 12 weeks; therefore, only short-term outcomes were available. Lack of complete clinical clearance at the patient level (RR, 1.26; 95%CI, 1.16-1.38; P < .00001; Figure 2A) and the proportion of warts not completely cleared at the lesion level (RR, 1.13; 95%CI, 1.05-1.21; P= .0006; Figure 2B) were significantly more common in patients treated with cryotherapy than in those treated with bleomycin.
CONCLUSIONS: In patients with common warts, intralesional bleomycin may be associated with higher short-term clearance than cryotherapy. However, these short-term findings are based on a very small number of heterogeneous randomized controlled trials with follow-up of up to 12 weeks, and recurrence and long-term cure could not be assessed. The certainty of the evidence is therefore low, and the results should be interpreted with great caution. In clinical practice, any potential gain in short-term clearance with intralesional bleomycin needs to be weighed against its greater procedure-related pain and local adverse events, as well as factors such as accessibility, clinical expertise, and individual patient preferences.