Recurrence rate of perianal and intra-anal genital warts treated with aminolevulinic acid photodynamic therapy: a meta-analysis

Objective This meta-analysis and systematic review aimed to evaluate the recurrence rate and clinical efficacy of aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of perianal and intra-anal genital warts. Methods We systematically searched the China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, Chinese Biomedicine (CBM), PubMed, and Cochrane Library databases from their inception to April 1, 2024, for randomized controlled trials (RCTs) investigating ALA-PDT for perianal and intra-anal genital warts. Study quality was assessed using the Cochrane Collaboration's risk of bias tool, and statistical analysis was performed using RevMan 5.3 software. Results After rigorous screening, 32 RCTs involving 2,538 patients were included. The recurrence rate of perianal and intra-anal genital warts treated with ALA-PDT was significantly lower than that in conventional treatment groups (OR = 0.17, 95% CI [0.13, 0.22], P < 0.00001). While ALA-PDT monotherapy demonstrated lower efficacy compared to conventional treatments (OR = 0.49, 95% CI [0.29, 0.85], P = 0.01), ALA-PDT combined with other therapeutic modalities showed superior clinical outcomes (OR = 4.72, 95% CI [3.53, 6.32], P < 0.00001). Conclusion ALA-PDT effectively reduces recurrence rates of perianal and intra-anal genital warts and enhances treatment efficacy when used in combination with conventional therapies. As all included studies were conducted in China, further multinational RCTs are warranted to validate these findings across diverse populations. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD42024501535.