Dosing
- Varies according to the condition and to the patient response. In general, the more frequent the applications, the brisker the cytokine inflammation and the more effective the therapy. Therefore, treatment must be individualized.
- Examples:
- Anogenital warts – 3x/ week for 12-16 weeks
- Actinic keratosis – twice/ week for 4 weeks and then re-cycle after a month of rest
- sBCC or SCC in situ – daily applications can be used if tolerated
Efficacy
Genital Warts
- Aldara™ 5% cream applied 3 times/ week for 4 months; 72% of warts in women and 33% in circumcised men
[Edwards L, et al. Arch Dermatol. 1998; 134:25-30]
- Clearance rates from the glans penis in uncircumsized men is considerably higher: total clearance was achieved in 62% of the patients in the 3 times/ week group and by 57% in the once-daily group.
[Gollnick H, et al. Int J STD Aids. 2001; 12:22-8]
- Experience suggests that external genital wart clearance is even better if combined with other destructive therapy such as cryotherapy or laser.
Compliance
- Local irritation is the most significant limiting factor.
- Note that irritation of the skin (cytokine-induced dermatitis) is a desired pharmacodynamic response.
- Titrating the frequency of applications is essential for optimal response and better tolerance of the therapy.
Cost of Treatment
- Cost of this drug is a problem for some patients.
- Cost effectiveness is seen if effective clinical response is realized, as well as the reduced costs of surgery and other medical interventions.
- The economic advantages of the possibility of imiquimod inducing a prolonged immune memory, which may reduce recurrences, has yet to be calculated.
