Efficacy and safety of Simiao decoction in the treatment of cervical HPV infection: A systematic review and meta-analysis of randomized clinical trials

Background: Persistent HPV infection can easily lead to the occurrence and development of cer-vical cancer and its precancerous lesions. Many studies have shown that Simiao Decoction may be effective in treating HPV infection, but the efficacy and safety of Simiao Decoction for HPV infection have never been systematically evaluated.Purpose: To evaluate the efficacy and safety of Simiao Decoction in the treatment of cervical HPV infection.Study design: A systematic review and meta-analysis of all randomized clinical trials (RCTs) comparing Simiao Decoction versus conventional treatment. Materials and methods: Seven databases were searched from their inception until May 14, 2023. All the RCTs comparing the efficacy and safety of Simiao Decoction versus conventional treatment were selected. Analyses were performed using Review Manager 5.3. HPV negative con -version rate (NCR) was defined as the primary endpoint, and treatment response rate (TRR), and adverse reaction (AR) were defined as the secondary endpoints. The quality of each endpoint was assessed by The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system.Results: Ten RCTs recruiting 799 patients with HPV infection were included. The results showed that compared with conventional treatment, Simiao Decoction improved NCR (RR = 1.45, 95 % CI 1.31, 1.61, P < 0.00001), TRR (RR = 1.24, 95%CI 1.15, 1.33, P < 0.000 01), while it did not increase AR (RR = 0.79, 95%CI 0.46, 1.33, P = 0.37). Most results were robust and the quality of evidence was moderate. Conclusion: Simiao Decoction is safer and more effective than conventional treatment for HPV infection. However, the efficacy and safety of Simiao Decoction should be further assessed by more high-quality RCTs with the outcome of HPV viral load and long-term follow-ups.