Imiquimod Is Effective in Reducing Cervical Intraepithelial Neoplasia: A Systematic Review and Meta-Analysis

Simple Summary There are publications on the use of Imiquimod in cervical intraepithelial neoplasia (CIN) and HPV clearance; however, the literature is not consistent about its efficacy. Moreover, in cervical precancers, surgical solutions are widely accepted therapies, despite their association with increased obstetrical complications, such as miscarriage and preterm birth. Therefore, a conservative solution is needed. Topical Imiquimod reduced CIN and enhanced HPV clearance, though surgical intervention conization was found to be more effective than Imiquimod treatment. Side effects were common, though mostly mild. Topical Imiquimod could be a valuable therapeutic option for CIN patients, especially for women who have future pregnancy desires. Imiquimod should be incorporated into guidelines as evidence shows it is effective and safe.Abstract 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 using I2 tested 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.