Evaluation of imiquimod for the therapy of external genital and anal warts in comparison with destructive therapies

Abstract

External genital and anal warts (acuminate condyloma) were the first medical indication the topical immune response modifier imiquimod was approved for in 1997. Since then, many placebo controlled randomized clinical trials have demonstrated the efficacy and safety of this synthetic imidazoquinoline derivate for the treatment of different human papillomavirus infections and tumours. Treatment modalities for genital warts (5% cream, three times weekly, minimum duration 4 weeks, control of side-effects) have been optimized and assured by further clinical trials and meta-analyses. For a few years clinical studies focussed on the long-term efficacy of the immunomodulatory therapy (sustained clearance from warts) and most recent studies compared the efficacy of ablative, destructive and imiquimod monotherapy as well as combination therapies.

Dermatologic manifestations of HPV in HIV-infected individuals

“…The β-papillomavirus genus refers to the phylogenetically related group of HPV types originally described in the skin of patients with epidermodysplasia verruciformis (EV), a rare genodermatosis characterized by development of disseminated fl at warts and extreme susceptibility to HPV infection. These HPV types found more frequently in EV skin lesions include 5, 8,9,12,14,15,17, and 19 through 25, and are also called "EV-type" HPVs. β-HPV may also play a role in development of nonmelanoma skin cancers (NMSCs) in non-EV patients.…”

Human papillomavirus–related genital disease in the immunocompromised host

“…The drug, which is applied by patients topically three times per week, enhances cell-mediated cytolytic activity against HPV. 11 Clinical trials report clearance rates of 40% to 70% with imiquimod therapy. [11][12][13][14] Several clinical studies have shown improved efficacy and lower recurrence rates (9-19% 15 ) with imiquimod when compared to placebo or other treatment modalities (level IB evidence).…”

“…13 The topical immune response modifier imiquimod has been licensed for the treatment of CA since 1997. 11 Imiquimod has no direct antiviral activity and is not chemodestructive or cytotoxic; instead, its mechanism of action is through induction of a T H 1-weighted host immune response. Specifically, imiquimod induces the production of cytokines including IFN and tumor necrosis factorealfa (TNF-a) via the activation Continued of Toll-like receptor 7, thereby activating dendritic and other immune cells.…”

“…[11][12][13][14] Several clinical studies have shown improved efficacy and lower recurrence rates (9-19% 15 ) with imiquimod when compared to placebo or other treatment modalities (level IB evidence). 11,13,14,16 Lower recurrence rates are not surprising given that eradication of warts by imiquimod is presumably accomplished by the body's own defenses rather than simply by lesional destruction. 13 The topical immune response modifier imiquimod has been licensed for the treatment of CA since 1997.…”

Uso de imiquimode tópico no tratamento da infecção anal pelo papilomavírus humano

“…Além disso, induz apoptose e ativa os linfócitos B, potencializando a resposta imunológica contra as células alteradas pelo HPV. (3)(4)(5)(6)(7)(8)(9)(10)(11) Aprovado para tratamento de condiloma anogenital em 1997, (12) foi liberado no Brasil pela Agên-cia Nacional de Vigilância Sanitária (ANVISA) para uso em maiores de 12 anos e recomendado para aplicação externa. Porém, há descrição na literatura de uso em criança de nove anos com regressão completa da lesão condilomatosa.…”