Supplementary Material for: Topical and Systemic Retinoids for the Treatment of Genital Warts: A Systematic Review and Meta-Analysis

Background: Genital warts, caused by the human papillomavirus, are a common sexually transmitted disease. The warts can regress spontaneously or exhibit a persistent clinical course. Various therapeutic modalities are available, yet none is curative, and there may be recurrences. Retinoids are considered the mainstay of therapy in many dermatologic diseases. Data on their use for genital warts are limited. Objective: To systematically review the published evidence on the efficacy and safety of retinoids for the treatment of genital warts. Methods: A systematic review and meta-analysis of all publications evaluating topical or systemic retinoids for the treatment of genital warts was performed. The primary outcome was complete response (CR); the secondary outcomes were recurrence rate and adverse events. Results: Six publications were evaluated, three randomized controlled trials and three prospective cohort studies, including a total of 141 patients with genital warts treated exclusively with retinoids (90% with isotretinoin). CR rates were 100% for systemic etretinate (3 out of 3 patients, 95% CI 28–81%) and 56% for isotretinoin (95% CI 28–81%; I2 = 84%). Topical etretinate did not induce CR. The most common side effect of topical agents was irritant contact dermatitis (36%) and that of systemic agents mucocutaneous disorders (80%). The relapse rate was 12% for oral isotretinoin and was unavailable for the other modalities. Conclusions: Current data suggest that unlike topical retinoids, systemic retinoids are an effective and safe treatment for genital warts. Further studies are required to determine their specific role and the most effective regimen for each derivative.

背景：由人乳头瘤病毒（human papillomavirus）感染引起的生殖器疣（Genital warts）是一种常见的性传播疾病。该疣体可自发消退，亦可呈现迁延不愈的临床病程。目前已有多种治疗手段可供选择，但均无法实现根治，且存在复发风险。维A酸类药物（retinoids）被认为是多种皮肤病治疗的核心疗法，但其用于生殖器疣治疗的相关研究数据较为有限。
目的：系统评价已发表的关于维A酸类药物治疗生殖器疣的有效性与安全性的研究证据。
方法：本研究针对所有评估外用或全身用维A酸类药物治疗生殖器疣的已发表文献开展系统评价与荟萃分析。主要结局指标为完全缓解（complete response, CR），次要结局指标为复发率与不良事件。
结果：共纳入6篇文献进行分析，包括3项随机对照试验（randomized controlled trials）与3项前瞻性队列研究（prospective cohort studies），共计141名仅接受维A酸类药物治疗的生殖器疣患者（其中90%使用异维A酸（isotretinoin））。全身用依曲替酯（etretinate）的完全缓解率为100%（3/3例患者，95%置信区间28%~81%），异维A酸的完全缓解率为56%（95%置信区间28%~81%，I²=84%）。外用依曲替酯未实现完全缓解。外用制剂最常见的不良反应为刺激性接触性皮炎（irritant contact dermatitis，36%），全身制剂最常见的不良反应为黏膜皮肤疾病（mucocutaneous disorders，80%）。口服异维A酸的复发率为12%，其余治疗方式的复发率暂无可用数据。
结论：现有数据表明，与外用维A酸类药物不同，全身用维A酸类药物是治疗生殖器疣的有效且安全的方案。未来仍需开展进一步研究，以明确各类维A酸衍生物的具体治疗地位及最优给药方案。