Adjuvant drug strategies in the treatment of recurrent respiratory papillomatosis

Abstract

The purpose of this study was to evaluate adjuvant drug therapies combined with standard laser excision in the treatment of recurrent respiratory papillomatosis. Previous studies have presented conflicting data on the efficacy of various treatments, including interferon and isotretinoin. A retrospective study of 34 patients with moderate to severe papillomatosis who underwent both laser surgery and adjuvant therapy was therefore performed. All patients were treated with interferon. Five interferon failures received isotretinoin, and three with recalcitrant disease received methotrexate. Interferon produced a complete response in 16 patients and partial response in 12 patients. Juvenile-onset disease had a slightly higher response to interferon than adult-onset disease. isotretinoin produced no response in all five patients. Methotrexate demonstrated a marked improvement in both severity of disease and treatment interval in all three patients. Serious side effects were limited to one interferon patient with febrile seizures, which resolved with discontinuation of therapy. We conclude that adjuvant therapy including interferon and methotrexate is clearly of benefit in the treatment of patients with respiratory papillomatosis. A detailed approach to surgery combined with an interferon dosing regimen is presented. Further study of methotrexate appears warranted.

Case Report: Recurrent Respiratory Papillomatosis: A Report of two cases and review of literature

“…9 There are reports of cases where the uses have demonstrated a marked improvement in both severity of the disease and surgical interval. 9,12 Both cases in this report have had adjuvant therapies with interferon and acyclovir in addition to surgeries. The economic and medical burden of RRP makes prevention of paramount importance.…”

“…3 The list of adjuvant medical therapy include; antiviral agents (acyclovir, ribavarin, cidofovir); interferon, retinoid (oral metabolite or analogue of vitamin A), photodynamic therapy, zinc, antireflux medication, cyclooxygease -2-inhibitor, methotrexate, preventive vaccine (mumps, MMR, quadrivalent HPV, heat shock protein E7) and gene therapy. [2][3][4][9][10][11][12] These treatment focus on several mechanisms like immunomodulation, disruption of molecular signalling cascade or HPV replication resulting in apoptosis, inhibition of proliferation, growth arrest and/or promotion of normal differentiation in HPV infected cells. 3 In both of the cases, acyclovir was employed as first line adjuvant medication.…”

Can zinc be an adjuvant therapy for juvenile onset recurrent respiratory papillomatosis?

“…Interferon is one of the initial adjuvant therapies introduced to treat JORRP and has been tried on a large number of patients [9][10][11][12][13][14][15][16][17][18][19][20].…”

Efficacy of Long-term Interferon-alpha Therapy in Adult Patients with Recurrent Respiratory Papillomatosis

“…The disease is noted for its highly unpredictable course, with rapid growth, spread within the respiratory tract, spontaneous resolution, and the constant possibility of airway obstruction requiring urgent intervention to maintain patency 9 . Due to the clinical variability of RRP, several methods of adjuvant therapy have been reported, including interferon-alpha (IFN-α), indole-3-carbinole, methotrexate, cidofovir, acyclovir, ribavirin, cis-retinoic acid, and photodynamic therapy [10][11][12][13][14][15] . Since 2002, Samsung Medical Center's guidelines have mandated regular injection of IFN-α in adult patients with RRP.…”