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Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation

The study found that ablative techniques, in particular carbon dioxide (CO2) laser therapy, are generally associated with higher probabilities of complete clearance of anogenital warts at the end of treatment and that the treatment strategy of podophyllotoxin 0.5% solution followed by CO2 laser therapy is likely to be considered a cost-effective use of resources.

Health Technology Assessment - NIHR Journals Library.

Version: March 2016
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Medical and surgical treatments for usual‐type vulval intraepithelial neoplasia (uVIN)

Usual‐type vulval intraepithelial neoplasia (uVIN) is a pre‐malignant condition affecting the vulval skin, which has the potential for progression to vulval cancer. Most patients have distressing symptoms that include itching, burning and soreness of the vulva, and painful intercourse. There may be white, brown, or red colour changes of the skin, breaks in the skin, or skin thickening. Usual‐type VIN is associated with infection with a virus called human papilloma virus (HPV or wart virus). Treatments are aimed at relieving distressing symptoms and ensuring that the condition does not become cancerous. The most common treatment option has been surgery to remove the affected skin areas. Surgery, however, does not guarantee a cure, can be disfiguring, and may result in physical and psychological problems. Alternatives include the use of laser technology to destroy the layer of affected skin, which may give better cosmetic results, but usually does not yield a specimen to exclude cancer. It may also be ineffective in treating uVIN that extends into hair follicles. Non‐surgical treatment alternatives include topical creams and gels, and HPV vaccines. This review aimed to assess the effectiveness and safety of these treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Comparison of non‐surgical treatments for women diagnosed with high‐grade VIN (precancerous changes of the vulva related to HPV‐infection)

This is an update of a Cochrane review previously published in 2011. Vulval intraepithelial neoplasia (VIN) is a skin condition affecting the vulval skin, which, if left untreated, may become cancerous. Distressing symptoms include itching, burning, and soreness of the vulva or painful intercourse. There may be discolouration and various other visible changes to the vulval skin. There are two types of VIN: the most common type (now known as usual‐type VIN or uVIN) is associated with infection of the cells of the vulva with a virus called human papilloma virus (HPV or wart virus), whereas the other type (known as differentiated‐type VIN) is not associated with this viral infection. As HPV infection is common, uVIN is becoming more common in younger women (under 50 years of age). At the moment treatments are aimed at relief of distressing symptoms and to ensure that the condition does not become cancerous.The most common treatment option for women with this condition has been surgery to remove the affected skin areas. Surgery, however, does not guarantee a cure, can be disfiguring, and may result in physical and psychological problems in younger women who are sexually active.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Sentinel lymph node status in vulval cancer: systematic reviews of test accuracy and decision-analytic model-based economic evaluation

This study aims to determine the test accuracy and cost-effectiveness of the sentinel lymph node (SLN) biopsy with 99mTc and/or blue dye compared with inguinofemoral lymphadenectomy or clinical follow-up for test negatives in vulval cancer. A sensitive and specific combined metastatic SLN detection test and information on generic quality of life in vulval cancer is urgently required.

Health Technology Assessment - NIHR Journals Library.

Version: December 2013
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Antivirals for recurrent respiratory papillomatosis

Recurrent respiratory papillomatosis (RRP) is a condition in which wart‐like growths occur in the upper airway of children or adults. This can cause difficulty in breathing or a change in voice. This condition is usually treated by repeated surgery to remove these 'warts', but it has been proposed that additionally using antiviral medications may help this condition. This review found one good quality study of cidofovir (an antiviral agent) injected into the warts at the time of surgical removal. After one year of treatment, however, this study found no benefit of the injected cidofovir when compared to injected salt water solution (placebo). There is still a need for a larger randomised study which includes more patients, and higher doses of cidofovir.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Valganciclovir for Off-Label Indications: A Review of Clinical Effectiveness [Internet]

Currently, valganciclovir is not yet indicated for solid organ transplant seropositive recipients, non-solid organ transplantation, such as stem cell transplantation, and other cytomegalovirus (CMV)-related diseases. The aim of this report is to review the clinical effectiveness of valganciclovir for off-label indications.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: July 27, 2015
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Antiviral agents for the treatment of recurrent respiratory papillomatosis: a systematic review of the English-language literature

OBJECTIVE: To determine the efficacy of antiviral agents for recurrent respiratory papillomatosis (RRP) in children and adults.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Treatment of polyomavirus infection in kidney transplant recipients: a systematic review

This review concluded that cidofovir or leflunomide addition to immunosuppression reduction therapy for polyomavirus-associated nephropathy management in kidney transplant recipients may not decrease graft failure rate; however, the evidence base was poor and more research is needed. Given this poor evidence base and the risk of bias in the review, the reliability of the authors' cautious conclusions is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Systematic Reviews in PubMed

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