Intralesional measles–mumps–rubella is associated with a higher complete response in cutaneous warts: a systematic review and meta-analysis of randomized controlled trial including GRADE qualification

Abstract

Introduction

Warts can be difficult to treat and progressing to chronic and resistant disease. Several studies have reported the successful application of mumps–measles–rubella (MMR) vaccine resulting in clearance of warts via immunomodulation and induction of immune system.

Methods

We performed a comprehensive search on the role of intralesional MMR in warts from several electronic databases. Complete response is defined as complete clearance of warts lesion.

Results

There were a total of 425 subjects from five studies. Intralesional injection of MMR was associated with an increased complete response (OR 9.43 [5.78, 15.37], p < .001; I²: 5%, p = .38). Subgroup analysis on patients receiving injection for every 2 weeks for a maximum of five injections revealed an OR of 11.70 [6.40, 21.38], p < .001; I²: 20%, p = .29. Patients receiving intralesional MMR were associated with a lower partial response (OR 0.54 [0.33, 0.88], p = .01; I²: 0%, p = .66). Intralesional MMR was associated with a reduced no-response (OR 0.16 [0.06, 0.43], p < .001; I²: 69%, p = .01). Funnel plot analysis for complete response was asymmetrical, indicating the risk of publication bias. There were statistically significant small-study effects for intralesional MMR on complete response upon analysis using Harbord’s test (p = .047). Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment showed that intralesional MMR injection has high level of certainty (quality of evidence) for complete response in warts with an absolute increase of 505 per 1000.

Conclusion

Intralesional MMR injection was associated with a higher complete response and lower no-response with a high level of certainty.

Keywords:

• Intralesional MMR
• measles–mumps–rubella
• warts

Disclosure statement

The authors declare that they have no conflict of interests.