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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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.

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.

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).

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
Issue number1
Early online date23 Jun 2023
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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