1. The use of intralesional Mycobacterium w (Mw) injection was equally as effective as the use of imiquimod 5% cream in the treatment of human papillomavirus (HPV).
2. Mw vaccine resulted in a significant decline in HPV-11 viral load when compared to imiquimod cream.
Evidence Rating Level: 2 (Good)
Study Rundown: HPV is a common sexually transmitted pathogen, with many strains known to cause anogenital warts (AGWs). A first-line treatment for AGWs is imiquimod 5% cream, an effective topical agent. Mw vaccine has been shown to produce similar immune responses when used to treat cutaneous warts, but its efficacy for the treatment of HPV has not been elucidated. Thus, this study sought to determine the effectiveness of Mw vaccine in the treatment of AGWs when compared to an imiquimod preparation. The use of intralesional Mw injection showed equal efficacy in achieving clinical and viral clearance of the HPV-6 virus as the traditional imiquimod 5% cream. Additionally the Mw vaccine was significantly more effective in decreasing HPV-11 viral loads. This was a well-designed study, however future research may benefit from a larger, more diverse population.
In-Depth [randomized controlled trial]: A total of 89 patients were included in this trial at the Department of Dermatology and Venereology, All Institute of Medical Sciences in New Delhi, India. Participants were randomized into two groups: Group 1, where 44 patients received imiquimod 5% cream and vehicle injection and group 2, where 45 patients received vehicle cream and Mw vaccine injection. Participants were examined at baseline and returned for follow-up visits every 2 weeks for 20 weeks. Variables between the two groups were compared using χ2 and Fisher exact tests. Both groups 1 and 2 showed equal effectiveness in the complete clearance of lesions (59% and 67% of participants, respectively) after treatments, while initial clearance was faster in group 1. The reduction in viral load was equal in both groups for HPV-6 (p=.01 and p=.003 for group 1 and group 2, respectively), but only significant in group 2 for HPV-11 (p=.03).
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