Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts

Abstract

Objectives: To evaluate the efficacy and cost effectiveness of self applied podophyllotoxin 0.5% solution and podophyllotoxin 0.15% cream, compared to clinic applied 25% podophyllin in the treatment of genital warts over 4 weeks. Methods: We conducted a randomised controlled trial in 358 immunocompetent men and women with genital warts of 3 months' duration or less. Results: In the principal analysis both podophyllotoxin solution (OR 2.93, 95% CI 1.56 to 5.50) and podophyllotoxin cream (OR 1.97, 95% CI 1.04 to 3.70) were associated with significantly increased odds of remission of all warts compared to podophyllin. We performed two further analyses. When subjects defaulting from follow up were assumed to have been cured odds of remission of all warts were also significantly increased both for podophyllotoxin solution (OR 3.04, 95% CI 1.68 to 5.49) and for podophyllotoxin cream (OR 2.46, 95% CI 1.38 to 4.40). When subjects defaulting from follow up were assumed not to have been cured odds of remission of all warts were significantly increased for podophyllotoxin solution (OR 1.92, 95% CI 1.13 to 3.27), but not for podophyllotoxin cream (OR 1.17, 95% CI 0.69 to 2.00). Local side effects were seen in 24% of subjects, and recurrence of warts within 12 weeks of study entry in 43% of all initially cleared subjects, without statistically significant differences between the treatment groups. Direct, indirect, and total costs were similar across the three treatment groups. Podophyllotoxin solution was the most cost effective treatment, followed by podophyllotoxin cream, with podophyllin treatment being the least cost effective. Conclusions: Self treatment of anogenital warts with podophyllotoxin showed greater efficacy and cost effectiveness than clinic based treatment with podophyllin.

Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation

“…[60][61][62][63][64][65][66][67][68] No preparation of podophyllotoxin is licensed by the EMA or FDA for the treatment of AGWs, but UK marketing authorisations have been granted for podophyllotoxin 0.5% solution (Condyline ® , Takeda Pharmaceuticals Company Ltd; Warticon ® solution, Stiefel Laboratories Ltd) and 0.15% cream (Warticon ® cream, Stiefel Laboratories Ltd) preparations.…”

In Vivo and in Vitro Antileishmanial Effects of Methanolic Extract From Bark of Bursera Aptera

“…Another compound found in the extract was palmitic acid, which induces mitochondrial pore opening and leads to a decrease of the mitochondrial membrane potential and then to cell death (Belosludtsev et al, 2006). Additionally, podophyllotoxin has been widely used topically in ethanolic solution and creams in the treatment of skin infections (Gilson et al, 2009;Lacey et al, 2003). This may be related to the antileishmanial activity in vivo, as the extract prevents the growth of the lesion without causing irritation or skin damage.…”

A Solanum incanum extract (SR-T100) regresses vulvar condyloma acuminatum and induces distinct autophagic and apoptotic responses in different types of HPV-infected cells

“…*P < 0.05; **P < 0.01. c The LC3-I and LC3-II proteins were detected by western blotting. The primary epithelial cells were infected with different types Lenti-HPV-E6/E7 virus for 24 h. After 24 h, the infected cells were incubated in culture medium in the presence or absence of the pan-caspase inhibitor Z-VAD-FMK (50 μM) for 30 min and then treated with SR-T100 (5 μg/ml) for 12 h. d The panel shows the percent change in the LC3-II/actin ratio compared with the untreated group in three independent experiments keratinocytes [25]. However, green tea extracts have antitumor and anti-proliferative effects and induce apoptosis in cancer cells by causing G0/G1-phase cell cycle arrest or stabilizing p53 via phosphorylation on critical serine residues [26].…”