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Many topical treatments exist for cutaneous warts and previous reviews of clinical trials did not follow intention-to-treat principles for analysis.
The objective of this meta-analysis and pooled analysis of randomized controlled trials (RCTs) was to determine the efficacy of topical treatments for cutaneous warts using intention-to-treat principles.
Systematic electronic searches (Cochrane library, Medline, Embase, Clinical trial registers) were conducted in May 2009 for trials of topical treatments for cutaneous warts that reported complete cure rate. Data was extracted from these trials and both random effects meta-analysis and pooled analysis of each treatment was performed. Statistical heterogeneity for the meta-analysis was assessed using the I2 statistic.
We found 78 relevant studies of which the majority were of low methodological quality. The results of the meta-analysis suggest that salicylic acid but not cryotherapy was superior to placebo. However, aggressive cryotherapy was significantly better than gentle cryotherapy. Combined therapy of salicylic acid and cryotherapy had a higher cure rate than either salicylic acid or cryotherapy alone. The pooled analysis found a higher mean cure rate with salicylic acid, cryotherapy and combined cryotherapy and salicylic acid therapy compared to placebo.
Evidence supports the use of salicylic acid and aggressive cryotherapy. In the absence of high quality trials, there is insufficient evidence from RCTs to support the use of other therapies.