The clinical effectiveness and safety of imiquimod versus podophyllotoxin in the topical treatment of condylomata acuminata: a systematic review and meta-analysis

Background: Imiquimod (IMQ) and podophyllotoxin (PDX) are two of the most common self-applied topical therapies for condyloma acuminatum. This review aims to directly compare their clinical effectiveness and safety profiles. Materials and methods: Records from two databases and two trial registers were screened for eligibility. The Mantel-Haenszel method was used for statistical analysis, using a fixed- or random-effects model depending on the calculated heterogeneity. Results: Five studies, two RCTs and three cohorts, were included. There was no statistically significant difference in the clinical effectiveness (RR = 0.98; 95% CI: 0.85–1.13; P = 0.74) and adverse effects (RR = 1.06; 95% CI: 0.73–1.53; P = 0.78) between IMQ and PDX. Subgroup analysis revealed a higher frequency of adverse effects with IMQ compared to PDX in adults (RR = 1.22; 95% CI: 1.03–1.46; P = 0.02) and a lower frequency in children (RR = 0.51; 95% CI: 0.27–0.99; P = 0.05), with a statistically significant difference between these two subgroups ( P = 0.01). The reviewed studies suggested that the time to complete clearance was comparable, wart recurrence was higher, and the time to recurrence was shorter in IMQ compared to PDX. IMQ may be slower in achieving complete clearance but better in preventing wart recurrence in vaccinated individuals. Conclusions: IMQ has comparable clinical effectiveness, more frequent adverse effects in adults, and less frequent adverse effects in children compared to PDX. Additionally, IMQ’s lower wart recurrence may suggest a potential benefit in vaccinated individuals. Thus, IMQ may be slightly better than PDX in these populations, which warrants further research. Nevertheless, the utilized studies had small sample sizes and inadequate power to draw reasonable conclusions (low certainty).