Treatment for cervical intraepithelial neoplasia (CIN) often consists of an excisional procedure. However, less invasive treatment methods have been explored, such as topical treatment with imiquimod cream. Imiquimod has been proven to be effective in the regression of vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VAIN). Previous studies have investigated the effect of imiquimod in CIN and showed well tolerated adverse effects. During a current study in the Netherlands, a number of adverse events have occurred. This case series presents a selection of these. Gynaecologists should be aware of the possible adverse effects of topical treatment with imiquimod cream.

ObjectiveA 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.MethodsDatabases 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.ResultsFive 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).ConclusionsThe histological regression rate is highest for surgical treatment followed by imiquimod treatment and placebo.

Review question / Objective: To determine the efficacy of topical imiquimod in treatment of high-grade CIN (defined as regression CIN 1 or less), and to determine the clearance rate of high-risk human papillomavirus (hr-HPV), compared to surgical treatment and placebo. Condition being studied: Women with an untreated, histologically proven, CIN2-3 lesion or women who were persistent high-risk HPV positive. Eligibility criteria: Studies that evaluated the efficacy of imiquimod treatment in intraepithelial lesions or malignancy of other organs, and studies published as conference abstract, narrative review, editorial, letter, or short communication were excluded.

Background Surgical treatment for high-grade cervical intraepithelial neoplasia (CIN) may affect future fertility and pregnancy outcomes, therefore alternative therapies are desirable. Objectives To determine the efficacy of topical imiquimod in treatment of high-grade CIN (defined as regression CIN 1 or less), and to determine the clearance rate of high-risk human papillomavirus (hr-HPV), compared to surgical treatment and placebo. Search strategy Cohort studies and trials up to July 2022 were searched with the terms imiquimod, cervical dysplasia, and HPV. Selection criteria Studies evaluating the efficacy of imiquimod in CIN lesions. Data collection and analysis The study followed the PRISMA checklist. Meta-analysis was conducted to determine the efficacy of imiquimod treatment. Main results Five studies involving 463 women with high-grade CIN were included. Imiquimod was associated with histological regression to CIN1 or less in 55% of cases versus 29% for placebo, and 93% for surgical treatment. Imiquimod-treated women had a greater odds ratio of histological regression to CIN1 or less than placebo-treated women (ORs 4.17, 95% CI 2.03-8.54). In comparison to imiquimod, surgical treatment had an odds ratio of 14.81 (95% CI 6.59-33.27) for histological regression to CIN1 or less. The hr-HPV clearance rate was 53.4% after imiquimod treatment and 66% after surgical treatment (ORs 1.53, 95% CI 0.62-23.77). Conclusions: Histological regression is higher in imiquimod treatment than placebo. Surgical treatment, which is currently the golden standard, shows a higher regression rate than imiquimod. Future studies should focus on patient selection and further development of alternative treatments.