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Most studies contained significant bias which prevented direct comparison. Reported complete response (CR) rates ranged between 14.3\u201378.6%, and 21.4\u201367% partial response (PR) rates of 3-weekly application for 16\u00a0weeks imiquimod course. A second course of imiquimod led to incremental response (CR 15\u201323.8%, PR 19\u201330%). Perianal HSIL showed superior response rates compared to intra-anal lesions (perianal HSIL CR ranging from 71.4 to 100%, intra-anal HSIL CR from 10.8 to 33.3%).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Discussion<\/jats:title>\n            <jats:p>In our systematic review we summarized the literature regarding imiquimod use for anal HSIL treatment, both perianal\/intra-anal. Imiquimod can be proposed as a safe treatment of anal HSIL, and perianal HSIL may benefit more from imiquimod treatment. However, anal HSIL recurrence rates were high, and there are no long-term data on its efficacy. No studies investigated the role of imiquimod in women or in HIV- patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Imiquimod can be proposed as a safe option for treatment of anal HSIL.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11912-025-01675-1","type":"journal-article","created":{"date-parts":[[2025,5,18]],"date-time":"2025-05-18T23:07:25Z","timestamp":1747609645000},"page":"833-843","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Imiquimod for Anal High Grade Intraepithelial Neoplasia: A Systematic Review"],"prefix":"10.1007","volume":"27","author":[{"given":"Niccol\u00f2","family":"Gallio","sequence":"first","affiliation":[]},{"given":"Mario","family":"Preti","sequence":"additional","affiliation":[]},{"given":"Elena","family":"Casetta","sequence":"additional","affiliation":[]},{"given":"Andreia","family":"Albuquerque","sequence":"additional","affiliation":[]},{"given":"Pedro","family":"Vieira-Baptista","sequence":"additional","affiliation":[]},{"given":"Fulvio","family":"Borella","sequence":"additional","affiliation":[]},{"given":"Federica","family":"Bevilacqua","sequence":"additional","affiliation":[]},{"given":"Camilla","family":"Cavallero","sequence":"additional","affiliation":[]},{"given":"Massimiliano","family":"Mistrangelo","sequence":"additional","affiliation":[]},{"given":"Alberto","family":"Revelli","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"1675_CR1","doi-asserted-by":"crossref","unstructured":"Gopalani SV, Senkomago V, Rim SH, Saraiya M. 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