Imiquimod 3.75% cream 250mg sachets

ObjectiveImiquimod, a toll-like receptor 7 agonist, is currently FDA-approved for treatment of actinic keratoses, superficial BCC, and external genital warts. It has also demonstrated promise in off-label use in the treatment of oral cavity leukoplakia and dysplasia. The aim of this scoping review is to summarize the current literature on this novel treatment strategy.Data sourcesCINAHL, Cochrane Library, PubMed, and SCOPUS.Review methodData sources were searched from inception through December 2024. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews. Studies reporting on oral leukoplakia or dysplasia treated with topical imiquimod were included, with primary outcome being lesion resolution or reduction.ResultsA total of 9 studies reporting on (N = 89) patients with (n = 99) lesions were included. The average age was 48.4 (range 43-66), and 48.6% were male. 5% topical imiquimod was used in varying treatment regimens, most commonly for 6 weeks in duration (7/9 papers). 34.3% of lesions had complete resolution, 43.4% had incomplete resolution, and 22.2% had no change in the lesion. The most commonly reported adverse effects were burning/soreness at the site (73.0%), fatigue (22.5%), oral lichen planus development or flare (11.2%), and flu-like symptoms (2.2%).ConclusionTopical imiquimod for the treatment of oral cavity leukoplakia and dysplasia is a promising new treatment strategy. Efficacy has been demonstrated in reducing lesion size and even complete lesion resolution, with minimal adverse effects. Further research is needed on this innovative therapeutic approach.

Abstract licence: CC BY-NC-ND

IntroductionInternational guidelines for the management of anogenital warts (AGWs) propose multiple first-line options but do not prioritize treatments based on safety or tolerability. This study aimed to compare the safety profiles of topical, systemic, and ablative treatments used for external AGWs in immunocompetent adults.MethodsA systematic review and frequentist network meta-analysis of randomized controlled trials published through August 2025 was performed. Adverse events (AEs) were classified as low-, moderate-, or high-grade local AEs (LGL, MGL, HGL) and low-grade general AEs (LGG). Relative risks were estimated using random-effects models with placebo as the reference.ResultsWe included 107 RCTs involving 12,423 participants. Ablative procedures were associated with higher rates of moderate-to-severe local AEs compared with topical therapies. Among topical treatments, imiquimod 5% and cidofovir cream were associated with lower rates of severe AEs, whereas podophyllotoxin was more often associated with LGL. SUCRA rankings placed topical treatments above ablative therapies in terms of tolerability. Cidofovir cream demonstrated the best safety profile, followed by imiquimod 5%.ConclusionThis network meta-analysis highlights significant differences in tolerability across AGW treatments and offers a comparative framework for patient-centered therapeutic decision-making. It also emphasizes the need for standardized AE reporting in future trials.

Abstract licence: CC BY-NC