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\begin{document}

\title{The efficacy of topical imiquimod in high-grade cervical intraepithelial
neoplasia: a systematic review and meta-analysis}



\author[1]{Anna van de Sande}%
\author[2]{Malika Kengsakul}%
\author[3]{Margot Koeneman}%
\author[4]{Marta Jozwiak}%
\author[5]{Kees Gerestein}%
\author[6]{Arnold-Jan Kruse}%
\author[7]{Edith M.G.  van Esch}%
\author[3]{Peggy de Vos van Steenwijk}%
\author[7]{Caroline L.P. Muntinga}%
\author[1]{Wichor M. Bramer}%
\author[1]{Folkert van Kemenade}%
\author[4]{Heleen van Beekhuizen}%
\affil[1]{Erasmus Medical Center}%
\affil[2]{Srinakharinwirot University Panyananthaphikkhu Chonprathan Medical Center}%
\affil[3]{Maastricht University Medical Centre+}%
\affil[4]{Erasmus MC Cancer Institute}%
\affil[5]{UMC Utrecht}%
\affil[6]{Isala Klinieken}%
\affil[7]{Catharina Hospital}%


\vspace{-1em}



  
  \date{May 25, 2024}


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\begin{abstract}
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.%
\end{abstract}%



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