Acyclovir in the Treatment of Recurrent Respiratory Papillomatosis

Abstract

Six patients with severe, recalcitrant, juvenile-onset recurrent respiratory papillomatosis were treated with 7 independent trials of acyclovir. In 2 trials, patients received acyclovir in place of interferon-alpha; the remaining 5 trials were in patients not otherwise receiving chemotherapy. Quantitative analysis of overall disease extent, laryngeal involvement, and degree of glottic obstruction for the 6 months prior to acyclovir administration and during acyclovir administration demonstrated a statistically significant decrease in all parameters evaluated in those patients who were otherwise unmediated. The 2 patients who discontinued interferon-alpha immediately prior to beginning acyclovir demonstrated worsening disease, consistent with the well-recognized rebound phenomenon associated with stopping interferon. This study suggests that acyclovir decreases the extent of respiratory papillomatosis in patients with recalcitrant disease. The beneficial effect of acyclovir appears to be insufficient to counteract the rebound of disease when interferon is stopped abruptly.

Treatment of severe laryngeal papillomatosis with intralesional injections of cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine]

“…A few reports have mentioned controversial results with acyclovir (Zovirax) in the treatment of recurrent respiratory papillomatosis. The number of patients was small, and therefore no definitive conclusions could be drawn [Endres et al, 1994;Kiroglu et al, 1994]. In fact, the mechanism of antiviral action of acyclovir, which is essentially based on phosphorylation by the virus-induced thymidine kinase, does not support its potential activity against HPV [Phelps and Alexander, 1995].…”

Recurrent respiratory papillomatosis

“…Evidence of efficacy is weak. 25 Indole-3-carbinol Indole-3-carbinol (I3C) is derived from cruciferous vegetables (sprouts, broccoli, cabbage) and is known to affect papilloma growth in vitro through its effect on oestrogen metabolism. Evidence of clinical efficacy is again equivocal.…”

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

“…Acyclovir: The regimens used are different (10 mg/kg 5Â/day for10 days then bid  6 weeks) (400-800 mg/day  6 months) and so are the results [36][37][38][39]. Its mode of action in this context is unclear.…”

“…Its mode of action in this context is unclear. Few side effects are noticed, including nausea, vomiting, diarrhea and headache [38]. Photodynamic therapy: It did not gain popularity though it has in general a positive effect [40][41][42].…”