Topical delivery of drugs in the treatment of high-grade cervical squamous intraepithelial lesions: A meta-analysis

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 296; pp. 131 - 139
• Main Authors: Liu, Shixuan, Zhang, Wenlei, Wang, Wenyan, Zheng, Jianlan
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2024
• Subjects: Cidofovir; Drug Therapy; Female; High-Grade Squamous Intraepithelial Lesion (HSIL); Histological Regression of Cervical Lesions; Humans; Imiquimod; Papillomavirus Infections; Pharmaceutical Preparations; Pregnancy; Squamous Intraepithelial Lesions; Uterine Cervical Diseases; Uterine Cervical Dysplasia - pathology; Uterine Cervical Neoplasms - pathology; Histological Regression of Cervical Lesions; High-Grade Squamous Intraepithelial Lesion (HSIL); Drug Therapy
• ISSN: 0301-2115; 1872-7654; 1872-7654
• DOI: 10.1016/j.ejogrb.2024.02.036

•To evaluate the efficacy of localized delivery of drugs in the treatment of HSIL.•In patients with recurrence after surgery, drug treatment can avoid secondary conization.•For HSIL patients, drug treatment can reduce adverse outcomes during pregnancy.•For HSIL, drug therapy can be used as a supplement to surgery. The present study aims to evaluate the efficacy and effect of localized delivery of drugs in the treatment of high-grade squamous intraepithelial lesion (HSIL) based on a meta-analysis. Databases including Cochrane Library, PubMed, Embase, Scopus, CNKI, and Wanfang were searched from their inception till August 2022. Randomized controlled trials (RCTs) that compared the efficacy of drugs and surgery in the treatment of HSIL were collected. A meta-analysis was performed using the software of Review Manager (version 5.4.1). Eight RCTs involving 523 patients were included in the meta-analysis. For HSIL, the rate of cervical lesions histological regression was 69.85 % in the surgery group and 59.88 % in the drug group, there was no significant difference between the two groups [OR = 0.45, 95 % CI (0.07, 3.03), P = 0.41]. The histological regression rate of cervical lesions in the placebo group was 37.76 %, and the difference between the drug group and the placebo group was statistically significant [OR = 4.94, 95 % CI (2.65, 9.20), P < 0.00001]. A total of four drugs were involved in the eight RCTS included in this study, which were imiquimod, 5-fluorouracil (5-FU), cidofovir and interferon. The results showed that although drug administration was effective in the histological regression of HSIL, the efficacy was less than about 10% of surgical treatment. Considering the recurrence of the disease after surgery and the problems of abortion, premature delivery and premature rupture of membranes after cervical conization in reproductive women, drug therapy can be used as a supplement to surgery or conservative treatment to promote the histological regression of cervical lesions in patients with HSIL.