Topical imiquimod 5% cream improves histological and composite clearance rates compared with other similar treatment options, such as methyl aminolevulinate photodynamic therapy, fluorouracil cream, and surgery in patients with basal cell carcinoma (BCC), a meta-analysis in the Journal of Dermatological Treatment reports.

Researchers from the Beijing Chao-Yang Hospital in China sought randomized controlled trials that assessed efficacy and safety of imiquimod 5% cream in patients with BCC. Only studies that included the cream with a comparison intervention, such as vehicle, excisional surgery, cryosurgery, fluorouracil, and methyl aminolevulinate photodynamic therapy, were included.

The literature review yielded a total of 13 studies with a pooled cohort of 4256 patients with BCC. Histological/composite clearance rate, success rate, complete response rate, tumor-free survival, and adverse events (AEs) were the main outcome measures of interest.

In the pooled analysis, a significantly higher histological clearance rate was observed with the imiquimod cream vs other treatment options (77.26% vs 4.54%, respectively; risk ratio [RR], 9.28, 95% CI, 5.56-15.49; P <.001). Treatment with imiquimod was also associated with significantly higher histological clearance rates compared with treatments for superficial BCC (RR, 20.94; 95% CI, 14.88-29.48; P <.001) and nodular BCC (RR, 4.88; 95% CI, 2.82-8.47; P <.001).

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Based on comparator treatments, imiquimod was associated with a higher histological clearance rate compared with vehicle (RR, 20.94; 95% CI, 14.88-29.48; P <.001) and cryosurgery (RR, 15.48; 95% CI, 11.67-20.54; P <.001). Complete response rate was also higher for imiquimod vs other treatments (77.8% vs 24.3%, respectively; RR, 3.15; 95% CI, 1.55-6.38; P =.001).

A higher rate of AEs was found for imiquimod vs the other pooled therapies (53.3% vs 35.8%, respectively; RR, 2.00; 95% CI, 1.39-2.88; P <.001). Imiquimod was associated with a higher incidence of itching (RR, 1.84; 95% CI, 1.62-2.09; P <.001), weeping (RR, 1.76; 95% CI, 1.45-2.14; P <.001), and headache (RR, 2.06; 95% CI, 1.05-4.04; P =.035), and a lower incidence of burning (RR, 0.59; 95% CI, 0.40-0.80; P =.001).

Limitations of the analysis include the small sample size in some of the included studies, as well as the lack of robust patient characteristic data in the studies. Also, the included studies lack homogeneity in the study population, as well as treatment protocols and follow-up duration.

The researchers noted that “clinicians should interpret our findings cautiously in light of the evidence of potential treatment-related side effects.”

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Reference

Jia HX, He YL. Efficacy and safety of imiquimod 5% cream for basal cell carcinoma: a meta-analysis of randomized controlled trial [published online July 22, 2019]. J Dermatolog Treat. doi:10.1080/09546634.2019.1638883