Imiquimod for actinic keratosis: Systematic review and meta-analysis
Imiquimod for actinic keratosis: Systematic review and meta-analysis
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DOI：
10.1038/sj.jid.5700264
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发表时间：
2006-06-01
影响因子：
6.5
通讯作者：
Moore, Robert A.
中科院分区：
文献类型：
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作者：
Hadley, Gina;Derry, Sheena;Moore, Robert A.
使用已发表的随机对照试验评估了使用免疫应答调节剂咪喹莫特治疗光化性角化病（AK）的益处和危害。五项随机双盲试验持续了12 - 16周，治疗了1，293名患者。与用媒介物治疗的5%相比，在用咪喹莫特治疗的50%的患者中发生完全清除，并且在12 - 16周后使其角化病完全清除的一名患者所需治疗的数量（NNT）为2.2（95%置信区间2.0 - 2.5）。对于部分（>= 75%）清除，NNT为1.8（1.7 - 2.0）。咪喹莫特组发生任何不良事件、任何局部不良事件或任何治疗相关不良事件的患者比例明显高于溶媒组，咪喹莫特组在12 - 16周内发生一次额外不良事件所需的伤害人数为3.2至5.9人。咪喹莫特的特定局部不良事件包括红斑（27%）、结痂或结痂（21%）、剥落（9%）、糜烂（6%）、水肿（4%）和流泪（3%）。5%咪喹莫特乳膏治疗AK有效，可预防潜在的鳞状细胞癌发展。未来的研究可能旨在阐明最佳剂量，以尽量减少不良事件而不损害疗效，并评估长期复发。
Benefit and harm associated with treating actinic keratosis (AK) with the immune response modifier imiquimod was assessed using published randomized-controlled trials. Five randomized double-blind trials lasted 12 - 16 weeks and treated 1,293 patients. Complete clearance occurred in 50% of patients treated with imiquimod, compared to 5% treated with vehicle, and the number needed to treat (NNT) for one patient to have their keratosis completely cleared after 12 - 16 weeks was 2.2 (95% confidence interval 2.0 - 2.5). For partial (>= 75%) clearance the NNT was 1.8 (1.7 - 2.0). The proportion of patients with any adverse event, any local adverse event, or any treatment-related adverse event was substantially higher with imiquimod than with vehicle, and numbers needed to harm for one additional adverse event with imiquimod over 12 - 16 weeks ranged from 3.2 to 5.9. Particular local adverse events with imiquimod included erythema (27%), scabbing or crusting (21%), flaking (9%), erosion (6%), edema (4%), and weeping (3%). Imiquimod 5% cream was effective in the treatment of AK, preventing potential development of squamous cell carcinoma. Future investigation might be aimed at elucidating optimal dosing to minimize adverse events without detriment to efficacy, and evaluating long-term recurrence.