5％咪喹莫特乳膏治疗尖锐湿疣Meta分析

目的以循证医学的方法对5％咪喹莫特乳膏治疗尖锐湿疣的疗效与安全性进行系统评价。方法检索PubMed、Ovid、Web of Seience、UMI、Elsevier以及Cochrane图书馆、中文科技期刊数据库（CNKI）、中国生物医学文献数据库（CBMDisc），纳入比较5％咪喹莫特乳膏与安慰剂或氟尿嘧啶乳膏的随机对照试验，南两名评价者独立提取资料并进行方法学质量评估。试验数据的统计分析采用Cochrane协作网提供的RevMan4．2培软件进行。结果最终纳入8个临床随机对照试验，对5％咪喹莫特乳膏治疗尖锐湿疣进行了Meta分析，与安慰剂组相比，差异具有统计学意义；与氟尿嘧啶乳膏组相比．疗效差异无统计学意义，没有报道与5％咪喹莫特乳膏临床应用相关的严重系统性不良反应。结论现有临床证据表明，5％咪喹莫特乳膏治疗尖锐湿疣有确切的疗效与较好的安全性。     

5%咪喹莫特乳膏治疗基底细胞癌Meta分析

目的以循证医学的方法对5%咪喹莫特乳膏治疗基底细胞癌的疗效与安全性进行系统评价。方法检索PubMed、Ovid、Web of Science、UMI、elsevier,以及Cochrane图书馆,纳入比较5%咪喹莫特乳膏与安慰剂的随机对照试验,由两名评价者独立提取资料并进行方法学质量评估。试验数据的统计分析采用Cochrane协作网提供的Rev Man4.2.8软件进行。结果最终纳入7个RCT,对其治疗浅表型基底细胞癌与结节型基底细胞癌进行了Meta分析,显示其与对照组相比,差异具有统计学意义,合并后前者RR=12.66(95%CI,3.56~45.06),后者RR=5.24(95%CI,2.54~10.81),没有报道与5%咪喹莫特乳膏临床应用相关的严重系统性不良反应。结论现有临床证据表明,5%咪喹莫特乳膏治疗浅表型基底细胞癌有确切的疗效与较好的安全性。疗效与剂量具有相关性,但每日2次与每日1次应用5%咪喹莫特乳膏临床疗效无差异。     

咪喹莫特乳膏治疗光化性角化病Meta分析

目的:以循证医学的方法对5%咪喹莫特乳膏治疗光化性角化病的疗效与安全性进行系统评价。方法:检索PubMed、Ovid、Web of Science、UMI、elsevier,以及Cochrane图书馆,纳入比较5%咪喹莫特乳膏与安慰剂的随机对照试验,由两名评价者独立提取资料并进行方法学质量评估。试验数据的统计分析采用RevMan 4.2.8软件进行。结果:最终纳入5个RCT,对其治疗光化性角化病进行了Me-ta分析,显示其与对照组相比,差异具有统计学意义,合并后RR=5.82(95%CI,3.44~9.83),没有报道与5%咪喹莫特乳膏临床应用相关的严重系统性不良反应。结论:现有临床证据表明,5%咪喹莫特乳膏治疗光化性角化病有确切的疗效与较好的安全性。     

不同疗程5％咪喹莫特乳膏预防尖锐湿疣的复发

目的 探讨应用不同疗程5％咪喹莫特乳膏预防尖锐湿疣复发的疗效和安全性。方法 采用随机、对照的方法，将患者分成3组：A组单用CO2激光治疗；B组用CO2激光祛除疣体后外用5％咪喹莫特乳膏4周，每周3次；C组用CO2激光祛除疣体后外用5％咪喹莫特乳膏8周，每周3次。所有患者均随访6个月。结果 共有90例外生殖器及肛周尖锐湿疣患者完成临床研究．6个月后．3组的复发率分别为64．29％、50％及21．88％，3组复发率比较，差异有统计学意义（P=0．0033）。外用咪喹莫特乳膏8周组复发率低于前两组；外用4周组与8周组复发率比较，差异有统计学意义（P=0．0207）。激光治疗后外用5％咪喹莫特乳膏4周组与8周组出现的不良反应率分别为73．33％．84．38％。不良反应包括：红斑、瘙痒、疼痛、灼热、糜烂、溃疡，以及流感样症状，两组差异无统计学意义（P〉0．05）。结论 激光治疗后外用5％咪喹莫特乳膏8周．皮损的复发率比外用4周明显下降。两组安全性无明显差异。     

疣体刮除术联合5％咪喹莫特乳膏治疗寻常疣的临床观察

目的：观察疣体刮除术联合5％咪喹莫特乳膏治疗寻常疣的临床疗效。方法：对30例寻常疣患者，给予疣体刮除后联合5％咪喹莫特乳膏封包治疗，并与同期30例CO：激光治疗的患者作对照。对比分析两组术后创面愈合、局部疼痛反应和复发率等。结果：首次治疗后第3天，联合治疗组、激光治疗组分别有24例、15例愈合良好，差异有统计学意义（Z=2．46，P=0．014）；联合治疗组疼痛反应明显轻于激光治疗组（Z=2．21，P=0．027）。治疗后6个月，联合治疗组疣体复发率低于激光治疗组，但差异无统计学意义（分别为6．7％、23．3％，χ^2=3．43，P=0．073）。结论：疣体刮除术联合咪喹莫特治疗寻常疣具有创面愈合快和疼痛反应轻等优点，但其抑制疣体复发的作用仍需进一步临床研究来证实。     

5%咪喹莫特乳膏对CO_2激光术后女性尖锐湿疣复发的预防作用

目的了解CO2激光术后局部外用5%咪喹莫特乳膏对女性生殖器尖锐湿疣(CA)复发的预防作用。方法 64例女性生殖器尖锐湿疣患者予CO2激光去除肉眼可见的疣体后随机分为A,B两组,每组32例,A组外用5%咪喹莫特乳膏,每周一、三、五或二、四、六晚各1次;B组外用重组人干扰素α-2b凝胶,4次/d。两组疗程均为8周,随访3个月,比较两组患者治愈、复发和不良反应情况。结果 A,B两组的治愈率分别为93.75%和71.88%,复发率为6.25%和28.12%,差异均有统计学意义(P均0.05);A,B两组不良反应发生率分别为65.60%和25.00%,差异也有统计学意义(P0.01)。结论 CO2激光去除疣体后局部外用5%咪喹莫特乳膏比重组人干扰素α-2b凝胶能更有效阻止女性生殖器尖锐湿疣的复发。     

CO2激光联合咪喹莫特乳膏预防尖锐湿疣复发疗效观察

目的探讨C02激光联合咪喹莫特乳膏预防尖锐湿疣（CA）复发的疗效。方法将74例患者随机分成两组，治疗组在CO2激光术后局部外用咪喹莫特8周，对照组单用CO2激光治疗，两组均随访3个月，观察患者复发情况。结果治疗组复发率为12．5％，对照组为38．2％，两组比较差异有统计学意义（P〈0．05）。结论CO2激光联合咪喹莫特乳膏治疗尖锐湿疣能明显降低其复发率。     

5%咪喹莫特乳膏治疗尖锐湿疣随机双盲临床研究

为评价国产咪喹莫特乳膏治疗外生殖器和肛周尖锐湿疣的临床疗效和安全性，采用随机、双盲、安慰剂平行对照研究方法。入选患者随机分为A、B两组，A组用基质安慰剂治疗，B组用5％咪喹莫特乳膏治疗，结果A组23例，B组24例按方案完成疗程。两组在治疗后2、4、6、8周治愈率、有效率均有显著性差异。两组不良反应严重程度比较无统计学差异。     

咪喹莫特乳膏预防尖锐湿疣复发随机对照临床观察

5％咪喹莫特乳膏（5％ Imiquimod cream）为非核苷类异环胺类药，是新型外用免疫调节剂。研究表明5％咪喹莫特乳膏用于治疗肛周及外生殖器疣疗效好，复发率低。为观察咪喹莫特预防外生殖器和肛周尖锐湿疣复发的临床疗效，笔者于2005年1～7月对41例患者进行观察，现将结果报道如下。     

咪喹莫特乳膏联合中药薰洗治疗尖锐湿疣的临床疗效分析

目的：分析咪喹莫特乳膏联合中药薰洗治疗尖锐湿疣的临床疗效.方法：选取我院2010年4月至2012年4月收治的134例尖锐湿疣患者,按照随机数字表分为观察组及对照组各67例,均接受咪喹莫特乳膏治疗,观察组在此基础上接受中药薰洗,比较两组患者的疗效、并发症及复发情况.结果：观察组治疗2周后总疣体数即显著下降,且停药后疣体数维持在较低水平,对照组治疗6周后总疣体数出现下降,但停药后疣体再次增多,两组患者治疗后疣体数存在显著统计学差异（P＜0.05）;观察组临床疗效显著优于对照组;观察组共出现12例并发症,均在停药后自行缓解,对照组出现30例并发症,其感染症状经对症治疗后缓解,观察组并发症发生率显著低于对照组;观察组复发4例,复发率6.0％,对照组复发11例,复发率16.4％,观察组复发率显著低于对照组.结论：咪喹英特乳膏联合中药薰洗治疗尖锐湿疣较单纯使用咪喹莫特乳膏具有更好的疗效及安全性,且可有效预防该病复发,是一种治疗尖锐湿疣的优秀方法,值得临床推广应用.     

Meta-analysis of 5% imiquimod and 0.5% podophyllotoxin in the treatment of condylomata acuminata

BACKGROUND: Genital warts are a common sexually transmitted disease caused by human papillomaviruses. Podophyllotoxin 0.5%, approved for patient self-administration, has been used most extensively in the treatment of genital warts. Imiquimod, a novel immune response modifier capable of inducing interferon-alpha and a variety of cytokines, has been examined as a potential treatment for genital warts. But 0.5% podophyllotoxin and 5% imiquimod have not been compared in any extensive and formal studies, although they are the common topical agents for genital warts. OBJECTIVE: To evaluate the efficacy and safety of topical 5% imiquimod and 0.5% podophyllotoxin in the treatment of genital warts. METHODS: We searched Medline (1966 to June 2005), Embase (1974 to June 2005) and the Cochrane Controlled Trials Register (issue 3, 2005). Randomized controlled trials of 5% imiquimod or 0.5% podophyllotoxin in the treatment of genital warts were collected. Two reviewers extracted the data and independently assessed the quality of the included medical literature. Then, meta-analysis was conducted. RESULTS: Twelve studies including 3 placebo-controlled trials of imiquimod and 9 placebo-controlled trials of podophyllotoxin were included. The clinical cure rates of imiquimod and podophyllotoxin were 50.34 and 56.41%, respectively, without statistically significant differences between the two (p > 0.05). A combined analysis of the 3 studies on imiquimod showed a statistically significant difference to the placebo group [pooled odds ratio (OR) 11.65, 95% confidence interval (CI) 6.05-22.44], as did a combined analysis of the 9 studies on podophyllotoxin (pooled OR 16.70, 95% CI 7.06-39.48). The most common adverse events of imiquimod were erythema, erosion, excoriation, itching and burning; those of podophyllotoxin were burning, pain, erosion, itching and inflammation. CONCLUSION: Imiquimod and podophyllotoxin possess similar curative effects on condylomata acuminata but podophyllotoxin has more serious adverse effects.     

Topical imiquimod 5% cream as an effective treatment for external genital and perianal warts in different patient populations

BACKGROUND: Genital infection with human papillomavirus, the cause of genital warts, is one of the most common sexually transmitted diseases. GOAL: The aim of this analysis was to determine whether patients' demographic variables affect the efficacy of imiquimod 5% cream versus vehicle cream for the treatment of external genital and perianal warts. STUDY DESIGN: Male and female immunocompetent patients applied imiquimod 5% cream topically to external genital warts 3 times a week until wart clearance or for up to 16 weeks. RESULTS: As previously published, the intent-to-treat (ITT) clearance rate was 50% (54/109) in the imiquimod-treated group and 11% (11/100) in the vehicle-treated group ( P< 0.0001). The ITT clearance rate in the imiquimod-treated group was higher in females (72%) than in males (33%). We have examined the clearance rates for subgroups based on variables of gender, baseline wart area, duration of current outbreak of warts, previous wart treatment, and tobacco use. For each of these subgroups, imiquimod was statistically more effective than vehicle in eradicating external genital and perianal warts. CONCLUSION: Imiquimod 5% cream is an effective treatment for external genital and perianal warts and provides a significant benefit in comparison with vehicle cream, independent of gender, initial wart size, duration of current outbreak of warts, previous wart treatment, or tobacco use.     

Management of Female Genital Warts with an Analog of Imiquimod 2% in Cream: A Randomized,Double-Blind,Placebo-Controlled Study

The purpose of this randomized, double-blind, placebo-controlled study was to determine the clinical efficacy and tolerability of an analog of imiquimod (2%) in cream to cure genital warts in women. Sixty preselected women, ranging between 18 and 45 years of age (mean 24.3) and having 411 lesions (mean 6.8) with clinical, histopathological and polymerase chain reaction (PCR) confirmed diagnosis of human papilloma virus (HPV) infection were randomized to two parallel groups. Each patient received a precoded 40-g tube and instructions on how to apply the trial medication to their lesions at home two times daily for five consecutive days per week. The active treatment period was six weeks. Patients were evaluated on a weekly basis. A clinically and PCR established total clearance of target warts was recorded as a cure. By the end of the treatment, 43.3% of patients and 42.8% of warts were cured. Code disclosure revealed that imiquimod cream had cured 83.3% of the treated patients and 84.3% of the treated warts, while the placebo healed one subject and four warts (p<0.0001). Eight patients (13.3%) in the imiquimod group experienced mild to moderate, non-objective, drug-induced symptoms with no dropouts. Among the 26 cured patients, five had a relapse after 11 months. In conclusion, the data presented demonstrate that 2% imiquimod in cream with mild to moderate subjective side effects is significantly more effective than placebo in eliminating genital warts in women.     

The role of imiquimod 3.75% cream in the treatment of external genital warts

Imiquimod 3.75% cream has recently been approved by both the U.S. Federal Drug Administration and Health Canada for the treatment of external genital warts. Herein, we provide an overview of external genital warts, review the phase 3 clinical trials leading to the approval of imiquimod 3.75% cream, and compare its efficacy and clinical use with imiquimod 5% cream. Moreover, therapeutic options have further expanded with the relatively recent introduction of sinecatechins 15% ointment, an extract of green tea leaves.     

Treatment of external genital warts in men using 5% imiquimod cream applied three times a week, once daily, twice daily, or three times a day

BACKGROUND: Medical therapy for genital warts remains suboptimal. The topical interferon and cytokine inducer, imiquimod, has been proved effective for the treatment of external genital and perianal warts, but there is a substantial difference in the response rates between men and women. When 5% imiquimod cream is applied three times a week up to 16 weeks, approximately two thirds of women treated with imiquimod achieve complete clearance of genital warts, whereas only about one third of men clear completely. GOAL: This study was undertaken to determine whether more frequent application of topical imiquimod cream would improve the rate of genital wart clearance in men. STUDY DESIGN: A randomized treatment trial involving adult men with biopsy-proven genital warts was conducted at nine centers in the United States and Canada using four different application frequencies. RESULTS: Complete clearance rates during the 16-week treatment period were as follows for the different imiquimod treatment frequencies: three times a week (35 %), once daily (28 %), twice daily (24%), and three times a day (27%)(P = 0.88). The four treatment groups all showed comparable reductions in the total lesion area, with a median of more than a 90% reduction in the lesion area by the end of treatment. There was a significant increase in the incidence and severity of local skin reactions including erythema, vesicle formation, ulceration, and excoriation as the dosing frequency increased from three times a week to three times a day. CONCLUSIONS: In this study, the optimal dosage regimen was the approved three times a week regimen. More frequent application (up to three times a day) did not improve clearance and was associated with an increase in local adverse events.     

A narrative review of the definition of ‘flare’ in hidradenitis suppurativa

Selecting a topical treatment from among the numerous topical agents for external genital warts remains challenging without clear evidence. Our aim was to evaluate comparatively the efficacy and safety of topical agents for external genital warts using a network meta-analysis. We included all randomized controlled trials that evaluated any topically applied treatment for external genital warts. Using the R package netmeta, network meta-analyses were performed with a frequentist approach. We identified 41 relevant studies comprising 6371 patients. Among conventional agents, podophyllotoxin 0·5% solution (odds ratio 1·94, 95% confidence interval 1·02–3·71) was significantly more efficacious than imiquimod 5% cream for lesion clearance; however, it was associated with a higher overall adverse event rate. Sinecatechins 15% ointment (odds ratio 0·21, 95% confidence interval 0·12–0·34) was significantly less efficacious than imiquimod 5% cream. Idoxuridine, polyhexamethylene biguanide, cidofovir and SB206 showed comparable therapeutic efficacies with conventional therapies. None of the treatments were significantly different from each other with respect to recurrence, patients with severe adverse events, or patients who withdrew because of treatment-related adverse events. Conventional modalities were efficacious and well tolerated, although each of them had their advantages and disadvantages. Additional efficacy and safety studies are warranted for unconventional agents. Linked Comment:   Doiron. Br J Dermatol 2020; 183 :5–6 .     

5%咪喹莫特乳膏治疗尖锐湿疣的临床研究

目的探讨5%咪喹莫特乳膏治疗尖锐湿疣的有效性和安全性。方法采用多中心、随机、双盲、安慰剂平行对照法对236例尖锐湿疣患者进行了8周的临床研究。结果有116例治疗组患者和120例对照组患者完成临床观察并纳入统计分析。两组治疗后2周、6周及治疗后8周在疗效评价方面有显著差异(P<0.05),不良反应主要是轻至中度的红斑、水肿、糜烂、刺痛及瘙痒。结论5%咪喹莫特乳膏是一种治疗外生殖器疣有效而安全的新药。     

5%咪喹莫特乳膏治疗尖锐湿疣多中心、随机、双盲研究

目的观察5%咪喹莫特乳膏治疗肛周和外生殖器尖锐湿疣的临床疗效和安全性。方法采用随机、双盲、平行对照的临床研究方法,受试者每周3次局部外搽研究药物,用药后6￣8h用清水清洗,疗程8周。疣体完全消退者继续随访1个月以观察复发率。结果共有231例肛周及外生殖器尖锐湿疣患者参加本次研究,其中5%咪喹莫特乳膏治疗组116例,安慰剂对照组115例。治疗后2、4、6、8周的痊愈率在治疗组分别为8.41%、30.84%、49.53%及61.68%,对照组分别为2.68%、7.14%、16.07%及24.11%,两组间差异有统计学意义(P<0.001);疗后2、4、6、8周的有效率在治疗组分别为34.58%、60.75%、68.22%及74.77%,对照组分别为10.72%、18.75%、28.57%及32.14%,两组间差异有统计学意义(P<0.001)。治疗组痊愈患者随访1个月后的复发率为10.61%,与对照组相比差异无统计学意义。治疗组无系统不良反应,仅有给药部位的局部不良反应,以轻度和中度红斑为多见,发生率为34.55%。结论5%咪喹莫特乳膏治疗肛周和外生殖器尖锐湿疣疗效好,安全性好,使用方便。