Imiquimod-induced effluvium after intravaginal application for treatment of cervical intraepithelial neoplasia

Borst, Carina; Grimm, Christoph; Tanew, Adrian; Radaković, Sonja

doi:10.1016/j.jdcr.2019.04.015

Cited by 7 publications

(10 citation statements)

References 10 publications

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“…Side effects and severe side effects (grade 2 and 3) were significantly more common in the imiquimod group compared to the LLETZ group (88.5% vs. 44.2% and 51.9% vs. 13.5%, respectively) and were the main reason for complete treatment discontinuation in the experimental arm. Overall, we know from previous data that treatment with imiquimod can be associated with a great number and variety of predominantly short-term side effects [18,37,38], whereas LLETZ is associated with short-and long-term side effects [10][11][12][13][14]39,40]. In the group of patients treated with imiquimod that were able to complete the treatment, we observed that the severity of side effects did not increase during the course of treatment.…”

Section: Discussionmentioning

confidence: 53%

Comparison of Conservative Treatment of Cervical Intraepithelial Lesions with Imiquimod with Standard Excisional Technique Using LLETZ: A Randomized Controlled Trial

Cokan

Pakiž

Serdinšek

et al. 2021

JCM

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(1) Background: There are limited data on the success of conservative treatment of high-grade cervical squamous intraepithelial lesions (HSIL) with imiquimod directly compared to standard of treatment with LLETZ. (2) Methods: Patients aged 18–40 with histological HSIL (with high-grade cervical intraepithelial neoplasia, CIN2p16+ and CIN3), were randomly assigned to treatment with imiquimod or LLETZ. The primary outcome was defined as the absence of HSIL after either treatment modality. The secondary outcomes were the occurrence of side effects. (3) Results: 52 patients were allocated in each group and were similar regarding baseline characteristics. In the imiquimod group, 82.7% of patients completed treatment, which was successful in 51.9%. All patients in the LLETZ group completed treatment, which was successful in 92.3% (p < 0.001). In the subgroup of CIN2p16+ patients, treatment with imiquimod was not inferior to LLETZ (73.9% vs. 84.2%, p = 0.477). During and after treatment, no cases of progression to cancer were observed. Side effects and severe side effects (local and systemic) were more prevalent in the imiquimod than in the LLETZ group (88.5% vs. 44.2% (p-value < 0.001) and 51.9% vs. 13.5% (p-value < 0.001), respectively). (4) Conclusion: Generally, in patients with HSIL, LLETZ remains the gold standard of treatment. However, in a subgroup analysis of patients with CIN2p16+, the success rate was comparable between the two treatment modalities. Due to the prevalence of side effects, the treatment compliance with imiquimod use may, however, present a clinically important issue.

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Section: Discussionmentioning

confidence: 53%

Comparison of Conservative Treatment of Cervical Intraepithelial Lesions with Imiquimod with Standard Excisional Technique Using LLETZ: A Randomized Controlled Trial

Cokan

Pakiž

Serdinšek

et al. 2021

JCM

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“…35 Temporary hair loss also was reported in two patients treated with imiquimod as a vaginal suppository. 36 Grimm et al 14 observed adverse events in 97% of patients treated with imiquimod. In our population, no adverse event was higher than grade 2.…”

Section: Discussionmentioning

confidence: 99%

Topical Imiquimod for the Treatment of High-Grade Squamous Intraepithelial Lesions of the Cervix

Fonseca¹,

Possati-Resende²,

Salcedo³

et al. 2021

Obstetrics &Amp; Gynecology

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“…In two RCTs, three cases of telogen effluvium were reported. 38,39 Because this symptom was first reported in 2019 and has not been reported in imiquimod treatment for other diseases, 38 the presence of measurement bias cannot be ruled out (Table 4). The pooled OR (95% CI) of HPV clearance was 9.50 (2.98-30.27) (Appendix 5G, http://links.lww.com/AOG/D233) (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…In all cases, hair loss was reversible and recovered within 2 to 9 months. 38,39 Telogen effluvium was reported in only the above three cases out of more than 500 cases, including observational studies. 38,39 However, the incidence of telogen effluvium should be evaluated further in future studies considering possible information bias resulting in underestimation of incidence.…”

Section: Discussionmentioning

confidence: 99%

Imiquimod for Cervical and Vaginal Intraepithelial Neoplasia

Inayama

Takamatsu

Hamanishi

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate the treatment efficacy and the risk of adverse events of imiquimod for cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia (VAIN), compared with placebo or no intervention. DATA SOURCES: We searched Cochrane, PubMed, ISRCTN registry, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform up to November 23, 2022. METHODS OF STUDY SELECTION: We included randomized controlled trials and prospective nonrandomized studies with control arms that investigated the efficacy of imiquimod for histologically confirmed CIN or VAIN. The primary outcomes were histologic regression of the disease (primary efficacy outcome) and treatment discontinuation due to side effects (primary safety outcome). We estimated pooled odds ratios (ORs) of imiquimod, compared with placebo or no intervention. We also conducted a meta-analysis of the proportions of patients with adverse events in the imiquimod arms. TABULATION, INTEGRATION, AND RESULTS: Four studies contributed to the pooled OR for the primary efficacy outcome. An additional four studies were available for meta-analyses of proportions in the imiquimod arm. Imiquimod was associated with increased probability of regression (pooled OR 4.05, 95% CI 2.08–7.89). Pooled OR for CIN in the three studies was 4.27 (95% CI 2.11–8.66); results of one study were available for VAIN (OR, 2.67, 95% CI 0.36–19.71). Pooled probability for primary safety outcome in the imiquimod arm was 0.07 (95% CI 0.03–0.14). The pooled probabilities (95% CI) of secondary outcomes were 0.51 (0.20–0.81) for fever, 0.53 (0.31–0.73) for arthralgia or myalgia, 0.31 (0.18–0.47) for abdominal pain, 0.28 (0.09–0.61) for abnormal vaginal discharge or genital bleeding, 0.48 (0.16–0.82) for vulvovaginal pain, and 0.02 (0.01–0.06) for vaginal ulceration. CONCLUSION: Imiquimod was found to be effective for CIN, whereas data on VAIN were limited. Although local and systemic complications are common, treatment discontinuation is infrequent. Thus, imiquimod is potentially an alternative therapy to surgery for CIN. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022377982.

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Imiquimod-induced effluvium after intravaginal application for treatment of cervical intraepithelial neoplasia

Cited by 7 publications

References 10 publications

Comparison of Conservative Treatment of Cervical Intraepithelial Lesions with Imiquimod with Standard Excisional Technique Using LLETZ: A Randomized Controlled Trial

Comparison of Conservative Treatment of Cervical Intraepithelial Lesions with Imiquimod with Standard Excisional Technique Using LLETZ: A Randomized Controlled Trial

Topical Imiquimod for the Treatment of High-Grade Squamous Intraepithelial Lesions of the Cervix

Imiquimod for Cervical and Vaginal Intraepithelial Neoplasia

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