A short, 8-week course of imiquimod 5% cream versus podophyllotoxin in the treatment of anogenital warts: A retrospective comparative cohort study
Electra Nicolaidou1, Antonios Kanelleas1, S Nikolakopoulos2, G Bezrodnii1, E Nearchou1, M Gerodimou1, E Papadopoulou-Skordou3, V Paparizos1, D Rigopoulos1
1 1st Department of Dermatology and Venereology, Sexually Transmitted Diseases Unit, School of Medicine, “Andreas Sygros” Hospital for Skin and Venereal Diseases, National and Kapodistrian University of Athens, Athens, Greece
2 Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Germany; Department of Statistics, CBS Laboratory, Athens University of Economics and Business, Athens, Greece
3 School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
1st Department of Dermatology, “A. Sygros” Hospital, 5, Dragoumi Street, 115 28 Athens
Source of Support: None, Conflict of Interest: None
Background: Studies comparing head-to-head treatment modalities for anogenital warts are lacking.
Aim: We sought to compare a short, 8-week course of imiquimod 5% cream to versus the standard 4 week course of podophyllotoxin in the treatment of anogenital warts and to assess factors that may affect response to treatment.
Methods: This was a retrospective cohort study. We reviewed medical files of otherwise healthy patients with a first episode of anogenital warts who were treated with either a short, 8-week course of imiquimod or the standard 4-week course of podophyllotoxin. Inverse probability of treatment weighted (IPTW). Logistic regression was employed to evaluate factors that may affect response to therapy.
Results: The study included 347 patients. In patients with lesions on dry, keratinized anatomical sites, the complete clearance rates were 7.6% for imiquimod and 27.9% for podophyllotoxin (P < 0.001). In patients with lesions on moist, partially keratinized sites, no difference between the treatments was revealed. Significant predictors of > 50% reduction in wart area were location of lesions [odds ratio (OR) (95% confidence interval (CI)): 3.6 (1.84–7.08), P = 0.0002] for “partially keratinized” versus “keratinized” sites and treatment used [OR (95% CI): 1.79 (1.08–2.97), P = 0.024] for podophyllotoxin versus imiquimod.
Limitations: The retrospective design of the study was a limitation that we mitigated against with the use of IPTW logistic regression.
Conclusion:A standard 4 week course of Podophyllotoxin was more effective than an 8-week course of imiquimod only for lesions on keratinized sites. Treatment with podophyllotoxin and location of lesions on partially keratinized sites were independent predictors of >50% reduction in wart area.