TREATMENT OF VAGINAL INTRAEPITHELIAL...

... Neoplasia (Primarily Low Grade) With Imiquimod 5 % Cream- An Updated Report

Fuente: Treatment of vaginal intraepithelial Neoplasia
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Buck HW, Watkins Memorial Student Health Center, University of Kansas, Lawrence, KS


OBJECTIVE:

Treatment of human papillomavirus (HPV) associated vaginal lesions (Vaginal intraepithelial neoplasia, VAIN) can be expensive, tedious and morbidity inducing. Imiquimod 5% cream, a safe and effective treatment of external genital warts, enhances the immune response to HPV infection.


METHODS:

Initial experience treating VAIN in 56 young women with imiquimod cream was reported in J Lower Gen Tract Dis 2003;4:290-293. 28 additional patients have been managed. A treatment course was 1 sachet of imiquimod 5% cream (0.25g) applied via vaginal applicator once weekly for 3 doses.


RESULTS:

The basic data of the initial group, the additional patients, and the groups combined are as follows


  • COMBINED
  • INITIAL
  • ADDITIONAL
  • TOTAL
  • Patients
  • 56
  • 28
  • 84
  • Complete
  • 42
  • 25
  • 67
  • Clear in 1 Course
  • 36
  • 18
  • 54
  • % in 1 Course
  • 86%
  • 72%
  • 81%
  • Lost to Follow-up
  • 14
  • 3
  • 17
  • % 1 Course Intent/Treat
  • 64%
  • 64%
  • 64%
  • % with CIN
  • 55%
  • 50%
  • 54%
  • % with Vulvar EGWs
  • 39%
  • 57%
  • 45%
  • Excoriation/adverse events
  • 2
  • 0
  • 2
  • Severity of VAIN:
  • VAIN 1: 79
  • VAIN 2: 3
  • VAIN 3: 2
  • More than 1 course: 2 courses: 10 patients; 3:1; 4:1; 6:1

CONCLUSIONS:

Additional experience continues to evidence to evidence the advantages of a very low dosing regimen of imiquimod 5% cream in the treatment of VAIN because of its simplicity of use, its high degree of effectiveness after a short treatment course, and the relative absence of associated adverse events.


KEY WORDS:

Vaginal intraepithelial neoplasia, immune response modifier, imiquimod 5% cream.