Intralesional measles, mumps, and rubella vaccine for cutaneous warts: A Systematic Review and Meta-analysis

Abstract

Background. Warts, caused by the human papilloma virus (HPV), are mucocutaneous proliferations controlled by cell-mediated immunity. Intralesional immunotherapy with measles, mumps, and rubella (MMR) vaccine, is postulated to induce a higher immune response for clearance of lesions. Objective. To assess the efficacy, safety and effect on recurrence of intralesional MMR vaccine for the treatment of warts. Methods. We searched online databases for randomized controlled trials on intralesional MMR vaccine for warts. Effects measured were the complete clearance of target and distant warts, adverse events noted and recurrence after treatment duration. Results. Four RCTs comparing intralesional MMR vaccine and placebo were assessed. Meta-analysis showed a risk ratio of 0.24 [95% CI: 0.18, 0.34] favoring intralesional MMR vaccine and a highly significant difference in completely clearing target warts (P-value <0.00001) versus placebo. Three of the 4 trials assessed response of distant warts showing a risk ratio of 0.28 [95% CI: 0.08, 0.96] and a significant difference (P=0.04) versus placebo. Pain and flu-like symptoms were the most common side effects with no recurrence seen after 3-6 months. Conclusions. Intralesional MMR vaccine significantly reduces and clears target and distant warts as compared to placebo. It is a generally safe intervention with lasting effect assessed up to 6 months follow-up.