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EVIDENCE BASED LARYNGOLOGY
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 22-26

Intralesional cidofovir for recurrent respiratory papillomatosis: Systematic review of efficacy and safety


Clinical Assistant Professor, University of British Columbia, Division of Pediatric Otolaryngology - Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, V6H 3V4, Canada

Correspondence Address:
N K Chadha
University of British Columbia, Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4
Canada
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Source of Support: None, Conflict of Interest: None


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Surgical debulking is the main treatment for recurrent respiratory papillomatosis (RRP); however, intralesional cidofovir has been widely used off-label as adjuvant therapy. Concern exists about the safety profile of this drug in humans. The objective of this systematic review was to explore current evidence for the efficacy and safety of intralesional cidofovir in RRP. A comprehensive search strategy was used in MEDLINE and the Cochrane Central Register of Controlled Trials. Human in vivo studies were eligible for inclusion. A total of 41 studies met the inclusion criteria, including 30 studies providing efficacy outcome data (one randomized controlled trial (RCT), two retrospective case-control studies, and 27 case series). The RCT showed no significant difference in outcome between placebo and intralesional cidofovir groups. One case-control study favored cidofovir, and the other favored the control group. Combining all series, the overall complete remission rate with intralesional cidofovir was 53%, with a rate of 63% in adult-only studies compared to 37% in pediatric-only studies. There was no evidence for an increased rate of dysplasia or malignancy associated with intralesional cidofovir. Vocal cord scarring was reported, and may be associated with higher doses, as may risk of nephrotoxicity through systemic absorption. High-quality evidence for efficacy of cidofovir is very limited. Intralesional cidofovir should only be used after informed consent, based on a discussion of available safety and efficacy evidence. This adjuvant therapy should only rarely be considered in children, as it may be less effective, and long-term risks are potentially increased.


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