Imiquimod As a First Line Treatment for Intra-Anal Condylomata Acuminata

Abstract

Background: Imiquimod, a topical immune response modifier, has been approved for the treatment of external anogenital warts and more specifically as a supplementary treatment option after ablative procedure. Despite that, few studies in the literature exist concerning imiquimod as a first line treatment for intra-anal warts. Aim: Prospective study to reveal the role of imiquimod as a first line monotherapy for intra-anal condylomata. Patients and Methods: 43 consecutive patients (8 females/35 males) with intra-anal warts underwent treatment with cream imiquimod 5%. Application was performed either by finger or by anal tampons 3 times per week (minimum Tx duration: 2 months and maximum: 4 months). Each month, during the ongoing treatment, the patients underwent anoscopy and blood examination. No improvement after two months therapy period, led to imiquimod cessation. Patients with partial response after maximum therapy period underwent supplementary treatment with APC. After condylomata eradication, all the treated patients underwent a surveillance programme for one year period. The study protocol was approved by the hospital protocol committee and written informed consent was obtained from each patient. Results: Intra-anal warts were eradicated completely in 26/43 (60.5%) patients with imiquimod monotherapy. Partial response reported in 10/43 (23.2%) of the patients after 4 months of treatment and required supplementary management with APC. The number and the duration of APC applications was remarkable less in these patients (1-2 applications, duration 4 to 6 min) comparatively with APC sessions in intra-anal condylomata naïve patients (3-6 applications, duration 15 to 20 min). In 7/43 (16.3%) patients imiquimod monotherapy was ineffective and these patients underwent treatment with APC. Imiquimod application method, either by anal tampons or by finger, seems to have no difference concerning the therapeutic success, even though the patients report better compliance and less discomfort with the finger application treatment. No side effects were observed during the treatment, except of a mild irridation of the perianal skin. None of the patients discontinue the treatment due to any reason. Conclusions: A. The use of imiquimod as first line monotherapy, seems to be a reliable, alternative method in the management of intra-anal warts, and the only self - applicable treatment for these kind of warts and B. Even when partial response is observed, facilitation of the following supplementary ablative treatment was reported. Further investigation is required to establish this study encouraging results and to delineate drug ineffectiveness in selected patients.