Pharmacotherapy of recurrent respiratory papillomatosis: an expert opinion.
BACKGROUND
Recurrent respiratory papillomatosis is caused by the human papillomavirus types (HPV) 6 and 11. It affects both children and adults. In a small number of cases, the disease can be very aggressive causing significant morbidity and possibly death. Surgical therapy is the primary treatment but in patients with aggressive disease, adjunctive therapy is initiated. The majority of these adjuncts center on immunomodulation, disruption of molecular signaling cascades or interruption of viral replication to help decrease the severity of the disease. Recently, a preventative vaccine has become available but data on its effectiveness will be at least a decade away. In the mean time, researchers are examining other vaccination strategies in the fight against HPV disease.


OBJECTIVE
We will review the following pharmacotherapies used in the adjunct treatment of RRP: interferon, acyclovir, ribivirin, cidofovir, COX-2 inhibitors, retinoids, anti-reflux medications, zinc, indole-3-carbinol, therapeutic/preventative vaccines.


METHODS
This is a review paper. Utilizing Medline and Pubmed from 1966 to present, the key words as well as the above listed adjunct treatments were searched for relevant papers.


CONCLUSIONS
The evidence supporting each of these adjuncts varies with a majority having only case reports or cases-series to support their use. However, there is hope on the horizon with regard to the HPV vaccine and its potential to prevent future transmission of this disease.
Gallagher
Thomas Q
TQ
Eastern Virginia Medical School, Norfolk, VA, USA.
Derkay
Craig S
CS
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D010212:Papilloma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D027383:Papillomaviridae / Q000302:isolation & purification / Q000502:physiology; D030361:Papillomavirus Infections / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D014412:Tumor Virus Infections / Q000188:drug therapy* / Q000473:pathology
D000998:Antiviral Agents