The typical threshold for treatment is CIN 2+, although a more restrained approach may be taken for young persons and pregnant persons. A Cochrane review found no clear evidence to show which surgical technique may be superior for treating CIN. Evidence suggests that while retinoids are not effective in preventing the progression of CIN, they may be effective in causing regression of disease in people with CIN2. Therapeutic vaccines are currently undergoing clinical trials. The lifetime recurrence rate of CIN is about 20%, but it isnt clear what proportion of these cases are new infections rather than recurrences of the original infection. Research to investigate if prophylactic antibiotics can help prevent infection in women undergoing excision of the cervical transformation zone found a lack of quality evidence.Surgical treatment of CIN lesions is associated with an increased risk of infertility or subfertility. A case-control study found that there is an approximately two-fold increase in risk i.The findings of low quality observational studies suggest that women receiving treatment for CIN during pregnancy may be at an increased risk of premature birth. People with HIV and CIN 2+ should be initially managed according to the recommendations for the general population according to the 2012 updated ASCCP consensus guidelines. Outcomes
It used to be thought that cases of CIN progressed through grades 1–3 toward cancer in a linear fashion.However most CIN spontaneously regress. Left untreated, about 70% of CIN 1 will regress within one year; 90% will regress within two years.
Difelikefalin, sold under the brand name Korsuva, is an analgesic opioid peptide used for the treatment of moderate to severe itching. It acts as a peripherally specific, highly selective agonist of the κ-opioid receptor (KOR).Difelikefalin was approved for medical use in the United States in August 2021.Difelikefalin acts as an analgesic by activating KORs on peripheral nerve terminals and KORs expressed by certain immune system cells. Activation of KORs on peripheral nerve terminals results in the inhibition of ion channels responsible for afferent nerve activity, causing reduced transmission of pain signals, while activation of KORs expressed by immune system cells results in reduced release of proinflammatory, nerve-sensitizing mediators (e.g., prostaglandins). Society and culture
Legal status
On 24 February 2022, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Kapruvia, intended for treatment of moderate-to-severe pruritus associated with chronic kidney disease. The applicant for this medicinal product is Vifor Fresenius Medical Care Renal Pharma France. Difelikefalin was approved for medical use in the European Union in April 2022. Research
It is under development by Cara Therapeutics as an intravenous agent for the treatment of postoperative pain. An oral formulation has also been developed. Due to its peripheral selectivity, difelikefalin lacks the central side effects like sedation, dysphoria, and hallucinations of previous KOR-acting analgesics such as pentazocine and phenazocine. In addition to use as an analgesic, difelikefalin is also being investigated for the treatment of pruritus (itching).