Antiviral agents for the treatment of recurrent respiratory papillomatosis: a systematic review of the English-language literature.

OBJECTIVE To determine the efficacy of antiviral agents for recurrent respiratory papillomatosis (RRP) in children and adults. STUDY DESIGN Systematic review to include randomized controlled trials (RCTs), comparative studies (historical and/or nonrandomized), case series, and case reports. RESULTS Twenty-six original studies were included (one case-control series, 21 noncomparative trials, four case reports, and no RCTs). Meta-analysis was not possible. The antiviral modalities included acyclovir, ribavirin, intravenous cidofovir, and intralesional cidofovir injections. The strongest evidence was for intralesional cidofovir, with 17 studies including 158 patients. Of these, 90 patients (57%) demonstrated complete resolution, 55 patients (35%) a partial response, and 13 patients (8%) showed no improvement. CONCLUSIONS Insufficient evidence from controlled trials exists for reliable conclusions, but several series indicate intralesional cidofovir may have some efficacy. A well-designed placebo-controlled, double-blinded, randomized controlled trial is needed. SIGNIFICANCE This study provides the background for future study design and a comprehensive review of the available evidence.