[Skip to Content]
[Skip to Content Landing]
Views 460
Citations 0
Original Investigation
January 2, 2020

Evaluation of Safety of Intralesional Cidofovir for Adjuvant Treatment of Recurrent Respiratory Papillomatosis

Author Affiliations
  • 1Bastian Voice Institute, Downers Grove, Illinois
  • 2Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
JAMA Otolaryngol Head Neck Surg. Published online January 2, 2020. doi:10.1001/jamaoto.2019.4029
Key Points

Question  Is intralesional injection of cidofovir safe to use as an adjuvant therapy for recurrent respiratory papillomatosis?

Finding  In this case series including 154 patients, intralesional injection of cidofovir was not associated with increased risk of dysplasia or carcinoma or a statistically significant increase in complications.

Meaning  Intralesional cidofovir injections may be considered for adjuvant therapy in patients with a high burden of disease with recurrent respiratory papillomatosis.


Importance  The use of intralesional cidofovir injections for recurrent respiratory papillomatosis (RRP) remains controversial owing to concern regarding the risks of its use, including increased risk of dysplasia or carcinogenesis.

Objective  To describe the rates of dysplasia, development of malignant lesions, and adverse events associated with use of intralesional cidofovir injections as adjuvant treatment for RRP compared with patients treated without adjuvant cidofovir.

Design, Setting, and Participants  In this case series performed at a tertiary care referral center, review of electronic medical records on all adult and pediatric patients (N = 154) treated for RRP with adequate follow-up from January 1, 2000, to December 31, 2016, was performed. Data were collected on the use of cidofovir, development and presence of dysplasia or malignant lesions, complications, and intersurgical interval.

Exposures  Adjuvant intralesional cidofovir or surgical excision only.

Main Outcomes and Measures  The main outcomes measured were the development of dysplasia, malignant lesions, and complications from treatment. These outcomes were determined before collection of data.

Results  Of the 154 patients included in the analysis, 83 patients (53.9%) received adjuvant intralesional cidofovir and 71 patients (46.1%) underwent surgical excision only. One hundred patients (64.9%) were male; mean age was 27.7 (95% CI, 24.3-31.2) years. Patients were followed up for a median (interquartile range) of 70 (24-118) months in the noncidofovir group and 91 (47-152) months in the cidofovir group. There were no statistically significant differences in the rates of development of dysplasia (2.8%; 95% CI, −8.3% to 13.2%) or malignant lesions (2.2%; 95% CI, −5.3% to 11.2%) between the groups. No nephrotoxic effects were observed in the treated cohort, and only 5 minor complications that occurred in 628 injections were noted in the cidofovir group; 3 were related to direct laryngoscopy and 2 were related to needle malfunction.

Conclusions and Relevance  In this cohort of patients with RRP, adjuvant intralesional cidofovir injections did not appear to cause major complications or an increased rate of development of dysplasia and cancer.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words