Isosorbide dinitrate ointment vs botulinum toxin A (Dysport^®) as the primary treatment for chronic anal fissure: a randomized multicentre study

Abstract

Dysport is more effective than ISDN ointment and has fewer side effects in the primary treatment of chronic anal fissure. The recurrence rate within 1 year in both treatment groups is high.

Botulinum toxin injection vs topical nitrates for chronic anal fissure: an updated systematic review and meta‐analysis of randomized controlled trials

“…Seven RCTs directly comparing BT and TN were captured through the search strategy. However, one of them was subsequently excluded as it allowed significant patient crossover between treatment groups such that if the respective therapy failed after 2 weeks patients were assigned to the other intervention group.…”

“…Furthermore, patients with persisting fissures 4 weeks after initial randomization subsequently received combination therapy with both BT and TN. Therefore, six published randomized studies describing a total of 393 patients were included in the final analysis. There were 194 patients in the BT group and 199 in the TN group.…”

“… and Berkel et al . employed a shorter cut‐off, with 4 and 6 weeks, respectively. No definition was provided by Abd Elhady et al .…”

“…On the other hand, Berkel et al . excluded patients with a history of prior botulinum toxin A injection and those who had completed prior nitrate therapy. No information regarding previous botulinum or nitrate exposure was provided in either of the Brisinda trials .…”

“…Berkel et al . also prescribed 1% ISDN ointment to be applied five times daily for 8 weeks. Abd Elhady et al .…”