Intralesional immunotherapy for non-genital warts: A systematic review and meta-analysis

Abstract

Background Intralesional immunotherapy has been reported to be effective for warts and to show good safety profiles, but this has not yet been systematically studied. Aims To determine the efficacy and safety of intralesional immunotherapy for treating non-genital warts. Methods We comprehensively searched the MEDLINE, Embase, Web of Science and Cochrane Library databases from the times of their inception to January 3, 2020. The primary outcome was the rate of complete response of all lesions. The distant complete response rate of warts located in an anatomically different body part and the recurrence rate were also analyzed. Results A total of 54 prospective studies was ultimately included. The immunotherapeutic agents used were Mycobacterium w vaccine, measles, mumps and rubella vaccine, purified protein derivative, Candida antigen, interferon, bacillus Calmette-Guérin vaccine and others. The pooled rate of complete response among all patients with non-genital warts treated using intralesional immunotherapy was 60.6% (95% confidence interval 54.8–66.5%). The pooled recurrence rate was 2.0% (95% confidence interval, 1.1–2.9%). All reported adverse events were mild and transient. Limitations The heterogeneity among studies Conclusion Intralesional immunotherapy is suggested for use in patients with multiple warts, given its promising results, good safety profile and low recurrence rate.

A prospective randomized controlled study of Mycobacterium Indicus Pranii vaccine, Measles Mumps Rubella vaccine and Vitamin D3 in extragenital cutaneous warts

“…However, response rates of 64%, 52%, and 53% observed in distant warts in the patients receiving vitamin D3 MIP, and MMR were higher than the overall rate of 51.6% reported based on previous studies. This difference was especially significant in the case of vitamin D3 where distant response rate of only 17.6% was reported based on previous studies 36 . Overall, since placebo injections with normal saline also achieved similar efficacy as immunotherapies with minimal side effects, the role of local injection trauma needs to be further addressed in future randomized case control trials.…”

“…This difference was especially significant in the case of vitamin D3 where distant response rate of only 17.6% was reported based on previous studies. 36 Overall, since placebo injections with normal saline also achieved similar efficacy as immunotherapies with minimal side effects, the role of local injection trauma needs to be further addressed in future randomized case control trials. We also hypothesize that the healing with placebo have a link with psychological aspect of the patient since Cw is a viral phenomenon linked with altered immunity and stress.…”

Systematic Review of Intralesional Therapies for Cutaneous Warts

“… Martin et al (2022) reported on intralesional therapies for plantar warts among 26 studies and 6 therapies, discussing the median cure rates for vitamin D3 (80%), bleomycin (74%), 5-FU (59%), Candida (66%), zinc sulfate (70%), and PPD (67%). Ju et al (2022) reported on intralesional immunotherapies and found a pooled 60.6% (95% CI = 54.8–66.5%) local complete response rate across MMR, Candida, vitamin D, PPD, IFN-a, MIP vaccine, bacillus Calmette–Guerin (BCG) vaccine, and 8 other therapies. Unique to their study is a reported pooled recurrence rate of 2.0% (95% CI = 1.1–2.9%).…”

“…Intralesional therapies are an emerging and effective approach for treating recalcitrant warts, particularly those situated in challenging regions such as palmoplantar and periungual areas, which often exhibit resistance to conventional treatments ( Mattoo and Bhatia, 2018 ). Several intralesional therapies for warts have emerged, including vitamin D3; tuberculin purified protein derivative (PPD); Candida antigen (Candida); the measles, mumps, rubella (MMR) vaccine; as well as various pharmaceutical mixtures, including immunotherapeutic drugs, digoxin–furosemide combinations, and antivirals such as acyclovir ( Aldahan et al, 2016 ; Fields et al, 2020 ; Ju et al, 2022 ). Unlike various other treatment options, immunotherapeutic approaches upregulate the immune system to recognize and destroy the lesions at both the target site and distant locations.…”

“…This approach has proven to be an inexpensive and effective method, particularly for individuals with multiple recalcitrant warts ( Aldahan et al, 2016 ). In comparison with conventional therapeutic methods, intralesional immunotherapy has demonstrated shorter treatment times, increased efficacy, a lower incidence of side effects, and reduced recurrence rates ( Ju et al, 2022 ; Martin et al, 2022 ). However, no Food and Drug Administration–approved treatment exists, nor is there consensus regarding the most efficacious intralesional therapy.…”