Imiquimod For The Treatment Of Genital Warts: A Quantitative Systematic Review

Objective:To assess the benefit and safety of 5% imiquimod in the treatment of genital warts.Method:According to cochrane Reviewer's Handbook and search strategy,the electronic databases were searched including the Cochrane library,MEDLINE,CBM,the randomized controlled trials (RCTs) about 5% imiquimod for the treatment of genital warts were included. Chinese Journal Of Dermatovenerology, Chinese Jounal of Dermatology, Journal of Clinical Dermatology and Foreign Medical Sciences(Section of dermatology and venereology)were hand searehed. The RCT studies meeting the inclusion criteria were selected.Two independent reviewers evaluate the trials. After that, Homogeneity,Meta-analysis were made by RevMan4.2 software. If Meta-analysis can't be done, qualitative descriptions were made.Results:There were 13 studies including 2017 patients met the inclusion criteria of this review,which were all RCTs.The results of Meta-analysis were expressed with OR and 95%Cl.(1) The clinical efficacy of 5 % ,2%,1%imiquimod cream were significantly better than placebo[8.09(3.88,16.87);145, (15.86,1325.30);2.78(1.43,5.39)].(2) The clinical efficacy of 5 % imiquimod cream were better than 1% imiquimod cream[4.77(3.00,7.56)].(3) The clinical efficacy of 5%imiquimod cream were not better than 2.5% flurouracil cream[1.08 (0.70,1.67)].(4) The clinical efficacy of 5%imiquimod cream applied once-daily,twice-daily,three times a day were not better than three times a week.(5) For female patients, there was no statistically significant difference in complete clearance rates across 4,8,12,16 week treatment.13 studies described local reactions, including erythema, burning,erosion, itching and oedema.No systemic side effects were reported.The side effects of 5%imiquimod cream were more than 1%imiquimod cream and placebo and would increase with using more frequency.Conclusions: Imiquimod cream in the topical treatment of anogenital warts is more effective than placebo cream. The efficacy of 5%imiquimod cream is better than 1%imiquimod cream. 5%imiquimod cream applied three times a week caused better efficacy and least incidence of side effects.For women,a four-week treatment course of 5%imiquimod applied thrice weekly may provide a reasonable approach with comparable efficacy and compliance.