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.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.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.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.
