The efficacy of topical imiquimod in high-grade cervical intraepithelial neoplasia: A systematic review and meta-analysis

A. J.M. van de Sande, M. Kengsakul*, M. M. Koeneman, M. Jozwiak, C. G. Gerestein, A. J. Kruse, E. M.G. van Esch, P. J. de Vos van Steenwijk, C. L.P. Muntinga, W. M. Bramer, H. C. van Doorn, F. J. van Kemenade, H. J. van Beekhuizen

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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Abstract

Objective:
A major side effect of cervical excision for high-grade cervical intraepithelial neoplasia (CIN) is premature birth. A non-invasive treatment for reproductive age women is warranted. The aim of the present study was to determine the efficacy of topical imiquimod in the treatment of high-grade CIN, defined as a regression to ≤CIN 1, and to determine the clearance rate of high-risk human papillomavirus (hr-HPV), compared with surgical treatment and placebo.

Methods:
Databases were searched for articles from their inception to February 2023.The study protocol number was INPLASY2022110046. Original studies reporting the efficacy of topical imiquimod in CIN 2, CIN 3 or persistent hr-HPV infections were included. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist.

Results:
Five studies were included (n = 463). Histological regression to ≤CIN 1 was 55% in imiquimod versus 29% in placebo, and 93% in surgical treatment. Imiquimod-treated women had a greater odds of histological regression to ≤CIN 1 than placebo (odds ratio [OR] 4.17, 95% confidence interval [CI] 2.03–8.54). In comparison to imiquimod, surgical treatment had an OR of 14.81(95% CI 6.59–33.27) for histological regression to ≤CIN 1. The hr-HPV clearance rate was 53.4% after imiquimod and 66% after surgical treatment (95% CI 0.62–23.77).

Conclusions:
The histological regression rate is highest for surgical treatment followed by imiquimod treatment and placebo.

Original languageEnglish
Pages (from-to)66-74
Number of pages9
JournalInternational Journal of Gynecology and Obstetrics
Volume164
Issue number1
Early online date23 Jun 2023
DOIs
Publication statusPublished - Jan 2024

Bibliographical note

Funding information:
This study was not funded.

Publisher Copyright:
© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

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