Intralesional immunotherapy for the treatment of warts: A network meta-analysis.

BACKGROUND: Without clear evidence, selecting among the existing immunotherapeutic options for warts remains challenging. OBJECTIVE: Through network meta-analyses, we aimed to evaluate the comparative efficacy of different intralesional immunotherapeutic modalities. METHODS: We included randomized controlled trials comparing intralesional immunotherapeutic modalities to cryotherapy, placebo, or imiquimod. All outcomes were presented as odds ratios (ORs) with 95% confidence intervals. Both conventional and network meta-analyses (with a frequentist approach) were conducted on R software. The P-score was used to rank different treatments. RESULTS: Network meta-analysis of 17 randomized controlled trials (1676 patients) showed that PPD (purified protein derivative vaccine, OR 39.56), MMR (measles, mumps, rubella vaccine, OR 17.46) and interferon ß (OR 15.55) had the highest efficacy in terms of complete recovery at the primary site compared with placebo. Regarding complete recovery at the distant site, autoinoculation (OR 79.95), PPD (OR 42.95), and MMR (OR 15.39) were all statistically superior to placebo. According to the P-score, MMR was more effective than other modalities in reducing the recurrence rate at the same site. LIMITATIONS: Relatively small sample size in some comparisons and variability in baseline characteristics. CONCLUSION: PPD and MMR were the most effective in achieving complete primary and distant recovery (along with autoinoculation for distant recovery) and reducing the recurrence rate at the same site compared with cryotherapy and other immunotherapeutic modalities.

Efficacy and safety of single dose of oral secnidazole 2 g in treatment of bacterial vaginosis: A systematic review and meta-analysis.

BACKGROUND: Bacterial vaginosis (BV) is a common disease characterized by vaginal discharge. OBJECTIVE: To evaluate the evidence from published randomized clinical trials (RCTs) about the efficacy and safety of single dose of oral secnidazole 2 g in comparison with other drugs. SEARCH STRATEGY: Electronic databases were searched using the following MeSH terms (bacterial vaginosis OR vaginosis) AND (secnidazole OR secnol OR sabima OR secnidal OR minovage). SELECTION CRITERIA: All RCTs assessing effect of secnidazole in treatment of BV were considered for this meta-analysis. Two-hundred thirty two studies were identified of which six studies were deemed eligible for this review. DATA COLLECTION AND ANALYSIS: The extracted data were entered into RevMan software. The relative risk (RR) and 95% confidence interval (CI) were calculated. The extracted outcomes were the clinical cure and adverse effects. MAIN RESULTS: The pooled estimate showed that ornidazole is superior to a single dose of oral secnidazole in clinical cure at the 4th week after treatment (RR = 0.81; 95% CI [0.73- 0.89], p < 0.0001, I2 = 0%). There were no difference between secnidazole and metronidazole (RR = 0.97; 95% CI [0.90-1.05], I2 = 0%, p = 0.5). CONCLUSIONS: Single oral dose of secnidazole 2 g doesn't differ from metronidazole regimen however, it may be inferior to ornidazole in treatment of BV.