Topical imiquimod works just as well as surgery for the first-line treatment of vulvar high-grade squamous intraepithelial lesions, according to a phase III non-inferiority trial.

Results from the multicentre Austrian study also showed no significant difference in rates of HPV clearance, adverse events or treatment satisfaction, the researchers say.

The Medical University of Graz-led team concluded that the immune response modifier is a “safe, effective and well accepted alternative to surgery” and can be considered first-line treatment in women with vulvar high-grade squamous intraepithelial lesions (vHSILs).

They assigned 110 affected women to surgical treatment or medical treatment with topical imiquimod, which was self-administered in escalating doses up to three times per week for 4-6 months.