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Current events in Obstetrics & Gynecology, updates on new web site features and links to other web sites of interest to ObGyns.

Tuesday, July 3, 2012

Trailers (28): Medical treatment of CIN

Grimm, et al. Treatment of cervical intraepithelial neoplasia with topical imiquimod: a randomized controlled trial

Why should you read about this topic?

Because HPV vaccines haven't eradicated cervical cancer yet.  We still have a lot of work to do with premalignant cervical lesions.

What were the authors trying to do?

Estimate the efficacy of topical, self-administered imiquimod (16 weeks) for treatment of high-risk HPV-associated CIN 2 and CIN 3

Who participated and in what setting?

Women (N=59) at least 18 years of age with high-risk HPV positive, newly diagnosed (satisfactory colposcopy[probably means adequate colposcopy with the entire squamo-columnar junction visible--see the paper by Bornstein et al]) CIN 2 or 3 at the Medical University of Vienna between 2009-10

What was the study design?

Randomized, double-masked, placebo-controlled trial comparing topical imiquimod with placebo

What were the main outcome measures?

Histologic regression to CIN 1 or less

What were the results?

Histologic regression:  imiquimod--73%; placebo--39%.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths: Randomized, double-masked, placebo-controlled trial.  Weaknesses: biopsies at multiple time points before and during the study may have affected the regression rates in both treatment arms.

What does the study contribute for your practice?

In selected patients with CIN, medical therapy may be an option in the future, but don't throw away your loops just yet.  Remember: this is an efficacy trial, not an effectiveness trial.