{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T21:10:28Z","timestamp":1790975428526,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,6,23]],"date-time":"2023-06-23T00:00:00Z","timestamp":1687478400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>A major side effect of cervical excision for high\u2010grade cervical intraepithelial neoplasia (CIN) is premature birth. A non\u2010invasive 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\u2010grade CIN, defined as a regression to \u2264CIN 1, and to determine the clearance rate of high\u2010risk human papillomavirus (hr\u2010HPV), compared with surgical treatment and placebo.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2010HPV infections were included. The study followed the Preferred Reporting Items for Systematic Reviews and Meta\u2010analyses checklist.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five studies were included (<jats:italic>n<\/jats:italic>\u2009=\u2009463). Histological regression to \u2264CIN 1 was 55% in imiquimod versus 29% in placebo, and 93% in surgical treatment. Imiquimod\u2010treated women had a greater odds of histological regression to \u2264CIN 1 than placebo (odds ratio [OR] 4.17, 95% confidence interval [CI] 2.03\u20138.54). In comparison to imiquimod, surgical treatment had an OR of 14.81(95% CI 6.59\u201333.27) for histological regression to \u2264CIN 1. The hr\u2010HPV clearance rate was 53.4% after imiquimod and 66% after surgical treatment (95% CI 0.62\u201323.77).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The histological regression rate is highest for surgical treatment followed by imiquimod treatment and placebo.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.14953","type":"journal-article","created":{"date-parts":[[2023,6,25]],"date-time":"2023-06-25T00:45:51Z","timestamp":1687653951000},"page":"66-74","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The efficacy of topical imiquimod in high\u2010grade cervical intraepithelial neoplasia: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"164","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7773-2758","authenticated-orcid":false,"given":"A. J. M.","family":"van de Sande","sequence":"first","affiliation":[{"name":"Department of Gynecological Oncology Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1638-1453","authenticated-orcid":false,"given":"M.","family":"Kengsakul","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam  Rotterdam The Netherlands"},{"name":"Panyananthaphikkhu Chonprathan Medical Center, Department of Obstetrics and Gynecology Srinakharinwirot University  Nonthaburi Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4650-9032","authenticated-orcid":false,"given":"M. M.","family":"Koeneman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Maastricht University Medical Centre  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3822-0749","authenticated-orcid":false,"given":"M.","family":"Jozwiak","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0490-2258","authenticated-orcid":false,"given":"C. G.","family":"Gerestein","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Division of Imaging and Oncology University Medical Center Utrecht, Utrecht University  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2460-6483","authenticated-orcid":false,"given":"A. J.","family":"Kruse","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Maastricht University Medical Centre  Maastricht The Netherlands"},{"name":"Department of Obstetrics and Gynecology Isala Clinics  Zwolle The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7387-5922","authenticated-orcid":false,"given":"E. M. G.","family":"van Esch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Catharina Cancer Institute, Catharina Hospital  Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9822-9529","authenticated-orcid":false,"given":"P. J.","family":"de Vos\u00a0van\u00a0Steenwijk","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Maastricht University Medical Centre  Maastricht The Netherlands"},{"name":"GROW \u2010 School for Oncology and Developmental Biology Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2886-3436","authenticated-orcid":false,"given":"C. L. P.","family":"Muntinga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Catharina Cancer Institute, Catharina Hospital  Eindhoven The Netherlands"},{"name":"GROW \u2010 School for Oncology and Developmental Biology Maastricht University  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2681-9180","authenticated-orcid":false,"given":"W. M.","family":"Bramer","sequence":"additional","affiliation":[{"name":"Medical Library Erasmus MC University Medical Centre  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1062-4485","authenticated-orcid":false,"given":"H. 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