Introduction:No hierarchy of first-line treatments for anogenital warts (AGWs) is provided in international guidelines. This study aimed to determine the efficacy of topical treatments and ablative procedures for the management of AGWs. Methods: Twelve electronic databases were systematically searched from inception to August 2018. All randomized controlled trials (RCTs) comparing immunocompetent adults with AGWs who received at least 1 provideradministered or patient-administered treatment in at least 1 parallel group were included. Risk of bias assessment followed the Cochrane Handbook. The study endpoint was complete lesion response after clearance and recurrence assessment. A network meta-analysis was performed. Results: A network geometry was constructed based on 49 of the 70 RCTs included in our systematic review. All but 4 RCTs had a high risk of bias. The most efficacious treatments compared to placebo were surgery (RR 10.54; CI 95% 4.53-24.52), ablative therapy ? imiquimod (RR 7.52; CI 95% 4.53-24.52), and electrosurgery (RR 7.10; CI 95% 3. 47-14.53). SUCRA values confirmed the superiority of surgery (90.9%), ablative therapy ? imiquimod (79.8%), and Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11604663.
Key Summary PointsWhy carry out this study?Anogenital warts (AGWs) are one of the most common sexually transmitted diseases, with an overall prevalence rate of around 1-5%.No clinically meaningful hierarchy of firstline treatments for anogenital warts is provided in international guidelines.What was learned from the study?Based on a low level of evidence, surgery and electrosurgery achieved the best complete lesion response after clearance and recurrence assessment.Podophyllotoxin 0.5% was the most efficacious patient-administered treatment.