Introduction: Topical Imiquimod is an immune response modifier approved for the off-label use of vulvar intraepithelial neoplasia. We conducted this systematic review and meta-analysis to investigate the efficacy and safety of Imiquimod in treating cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV)-positive patients. Methods: The study was prospectively registered (CRD420222870) and involved a comprehensive systematic search of five medical databases on 10 October 2022. We included articles that assessed the use of Imiquimod in cervical dysplasia and HPV-positive patients. Pooled proportions, risk ratios (RRs), and corresponding 95% confidence intervals (CIs) were calculated using a random effects model to generate summary estimates. Statistical heterogeneity was assessed usingI2tested by the Cochran Q tests. Results: Eight articles reported on 398 patients who received Imiquimod out of 672 patients. Among CIN-2–3 patients, we observed a pooled regression rate of 61% (CI: 0.46–0.75;I2: 77%). When compared, Imiquimod was inferior to conization (RR: 0.62; CI: 0.42–0.92;I2: 64%). The HPV clearance rate in women who completed Imiquimod treatment was 60% (CI: 0.31–0.81;I2: 57%). The majority of side effects reported were mild to moderate in severity. Conclusions: Our findings indicate that topical Imiquimod is safe and effective in reducing cervical intraepithelial neoplasia and promoting HPV clearance. However, it was found to be inferior compared to conization. Imiquimod could be considered a potential medication for high-grade CIN patients and should be incorporated into guidelines for treating cervical dysplasia.
引言：局部应用咪喹莫特是一种免疫调节剂，已获批用于外阴上皮内瘤变的超说明书治疗。本研究通过系统综述与荟萃分析，探讨咪喹莫特治疗宫颈上皮内瘤变（CIN）及人乳头瘤病毒（HPV）阳性患者的疗效与安全性。方法：本研究已前瞻性注册（CRD420222870），并于2022年10月10日系统检索了五个医学数据库。纳入标准为评估咪喹莫特治疗宫颈上皮内瘤变及HPV阳性患者的文献。采用随机效应模型计算汇总比例、风险比（RR）及相应95%置信区间（CI），并通过Cochran Q检验评估统计学异质性。结果：在672例患者中，8篇文献报告了398例接受咪喹莫特治疗的患者。在CIN-2–3级患者中，观察到汇总消退率为61%（CI：0.46–0.75；I²：77%）。对比分析显示，咪喹莫特疗效低于宫颈锥切术（RR：0.62；CI：0.42–0.92；I²：64%）。完成咪喹莫特治疗的患者HPV清除率为60%（CI：0.31–0.81；I²：57%）。报告的不良反应多数为轻度至中度。结论：局部应用咪喹莫特能安全有效地促进宫颈上皮内瘤变消退及HPV清除，但其疗效低于宫颈锥切术。咪喹莫特可作为高级别CIN患者的潜在治疗选择，建议纳入宫颈上皮内瘤变治疗指南。
肿瘤(癌症)患者之家