Recurrence rate of perianal and intra-anal genital warts treated with aminolevulinic acid photodynamic therapy: a meta-analysis

TL;DR

This study finds that aminolevulinic acid photodynamic therapy (ALA-PDT) significantly reduces the recurrence of genital warts, especially when combined with other treatments.

Contribution

The study provides a meta-analysis showing ALA-PDT's effectiveness in reducing genital wart recurrence, particularly in combination with other therapies.

Findings

ALA-PDT significantly lowers recurrence rates of perianal and intra-anal genital warts compared to conventional treatments.

Combining ALA-PDT with other therapies improves clinical outcomes significantly.

Most studies were from China, suggesting the need for multinational trials to confirm results in diverse populations.

Abstract

This meta-analysis and systematic review aimed to evaluate the recurrence rate and clinical efficacy of aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of perianal and intra-anal genital warts.

We systematically searched the China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, Chinese Biomedicine (CBM), PubMed, and Cochrane Library databases from their inception to April 1, 2024, for randomized controlled trials (RCTs) investigating ALA-PDT for perianal and intra-anal genital warts. Study quality was assessed using the Cochrane Collaboration's risk of bias tool, and statistical analysis was performed using RevMan 5.3 software.

After rigorous screening, 32 RCTs involving 2,538 patients were included. The recurrence rate of perianal and intra-anal genital warts treated with ALA-PDT was significantly lower than that in conventional treatment groups (OR = 0.17, 95% CI [0.13, 0.22], P < 0.00001). While ALA-PDT monotherapy demonstrated lower efficacy compared to conventional treatments (OR = 0.49, 95% CI [0.29, 0.85], P = 0.01), ALA-PDT combined with other therapeutic modalities showed superior clinical outcomes (OR = 4.72, 95% CI [3.53, 6.32], P < 0.00001).

ALA-PDT effectively reduces recurrence rates of perianal and intra-anal genital warts and enhances treatment efficacy when used in combination with conventional therapies. As all included studies were conducted in China, further multinational RCTs are warranted to validate these findings across diverse populations.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024501535.

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