Recurrent Respiratory Papillomatosis Medication

Updated: Dec 31, 2015
  • Author: Eloise M Harman, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Medication

Medication Summary

No drug can cure RRP. Several drugs appear to slow the growth of papillomas and increase the interval between necessary surgical debulking procedures. Intralesional cidofovir is frequently effective; however, because optimal dosing and long-term effects are not known, it should probably be reserved for persons with moderate-to-severe disease. [26] Dietary supplementation with oral indole-3-carbinol is often effective. Because of its adverse effects, treatment with interferon is now used infrequently as second-line therapy for patients with refractory severe disease. Control of gastroesophageal reflux is beneficial in children with RRP.

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Dietary Supplements

Class Summary

Certain types of vegetable extracts appear to improve symptoms.

Indole 3-carbinol (I3-C)

I3-C or its derivative, diindolylmethane (Indolplex), may be the active substance in cruciferous vegetables. I3-C changes the ratio of estradiol metabolites to the 2-hydroxyl derivative; this slows papilloma growth. Anecdotal experience demonstrates improvement in the disease with consumption of cabbage juice or a diet high in cruciferous vegetables (eg, cabbage, cauliflower, broccoli, Brussels sprouts). In clinical trials, one third of patients had a complete response and one third had a partial response to I3-C.

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Antiviral Agents

Class Summary

Nucleoside analogs are phosphorylated initially by viral thymidine kinase to eventually form a nucleoside triphosphate and inhibit viral replication.

Cidofovir (Forvade, Vistide)

Currently approved for treatment of CMV retinitis in AIDS. First member of a group of antivirals known as acyclic phosphonate nucleotide analogs. In infected cells, nucleotide analogs such as cidofovir inhibit viral DNA polymerase, which is responsible for replication of new viral RNA and DNA. Because HPV is the causal agent for RRP, eradication of the virus offers the potential for cure. Small trials have reported that intralesional use is beneficial. In a prospective trial of 16 RRP patients, 77% of the 13 patients available for follow-up experienced remission of disease after an average of 3.5 injections.

Acyclovir (Zovirax)

Inhibits viral DNA synthesis. A synthetic deoxyguanosine analog and the prototype antiviral agent that is activated by viral thymidine kinase. In small numbers of patients, acyclovir started on the day of surgical resection appeared to slow the rate of regrowth of papillomas. Combined treatment with interferon may decrease the rebound regrowth sometimes noted with interferon discontinuation.

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Interferons

Class Summary

Naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alfa, beta, and gamma interferons may be administered topically, systemically, and intralesionally.

Interferon alfa-2a (Roferon A)

Exerts antiviral effects by inhibiting translation of viral proteins. In the absence of an effective antiviral agent, use of drugs that augment host defense is a reasonable approach. Seventy-five to 80% of patients respond to interferon, with a complete response in approximately 30%. Does not eradicate the virus, and relapse may occur after discontinuation of treatment. Usually is administered for at least 6 mo in patients who require more than 3-4 surgical procedures each year. Case reports suggest that combined treatment with acyclovir or retinoic acid may be beneficial in patients with recurrent disease during interferon treatment.

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