Dr Sajid and colleagues from the United Kingdom conducted a systematic review of prospective randomized controlled trials on the effectiveness of botulinum toxin and glyceryltrinitrate for the pharmacological management of chronic anal fissure.
|Glyceryltrinitrate was associated with higher incidence of total side effects|
Prospective randomized controlled trials were selected according to specific criteria and analyzed to generate summative data.
The team retrieved 6 studies encompassing 355 patients with chronic anal fissure from electronic databases.
Only 3 randomized controlled trials on 180 patients qualified for the meta-analysis according to inclusion criteria.
There were 90 patients in botulinum toxin, and 90 in the glyceryltrinitrate group.
Botulinum toxin and glyceryltrinitrate were equally effective in healing/improving the chronic anal fissure.
The team found no statistically significant difference between the 2 pharmacotherapies.
However, there was statistically significant heterogeneity among the trials.
On fixed effect model, glyceryltrinitrate was associated with higher incidence of total side effects.
Dr Sajid's team concluded, "Botulinum toxin is as effective as glyceryltrinitrate for the management of chronic anal fissure but it is associated with a lower complication rate."
"Botulinum toxin can be recommended as a first-line therapy for chemical sphincterotomy in patients of chronic anal fissure."
"However, a major and multi-centre randomized controlled trial is required to support this treatment approach in order to establish stronger evidence."