From the Guidelines
Patients with recurrent respiratory papillomatosis should exercise caution when considering upadacitinib due to its immunosuppressive effects, which may potentially worsen the condition by reducing the body's ability to control human papillomavirus (HPV) replication. Upadacitinib, a JAK inhibitor, is typically used for inflammatory conditions like rheumatoid arthritis, and its impact on viral infections like those causing RRP is a concern 1. Since RRP is caused by HPV, particularly types 6 and 11, immunosuppression might theoretically exacerbate the condition.
Key Considerations
- Before starting upadacitinib, patients with RRP should undergo thorough evaluation by both their ENT specialist managing their RRP and the physician prescribing the JAK inhibitor.
- Close monitoring for worsening of papillomas would be essential if treatment is initiated.
- The decision should balance the benefits of upadacitinib for the patient's inflammatory condition against the theoretical risk of exacerbating their RRP.
- Alternative treatments with less immunosuppressive potential might be considered if appropriate for the patient's primary condition requiring treatment, as suggested by guidelines for managing high-risk populations, including those with immunosuppressive conditions or treatments 1.
Management and Monitoring
Given the potential risks, it is crucial to weigh the benefits of upadacitinib against the potential for worsening RRP. Surgical management, as outlined in clinical practice guidelines for hoarseness (dysphonia), including the use of contemporary laryngeal instruments for recurrent respiratory papillomatosis, should continue as necessary 1. The primary goal is to prevent airway obstruction and reduce symptoms of dysphonia while considering the overall impact of immunosuppressive therapy on the patient's condition.
From the Research
Treatment Options for Recurrent Respiratory Papillomatosis
- The current treatment options for recurrent respiratory papillomatosis (RRP) include surgery, adjuvant therapies, and immunotherapy 2, 3, 4, 5.
- Adjuvant therapies such as bevacizumab, a monoclonal antibody, have shown promise in treating RRP, especially in cases where surgical treatment is not effective 4, 5.
- Immunotherapy, including the use of human papillomavirus (HPV) vaccines, has also been explored as a potential treatment option for RRP 3, 4, 6.
Use of Upadacitinib in RRP Treatment
- There is no direct evidence in the provided studies to support the use of upadacitinib in the treatment of RRP.
- However, the use of biologics, including those targeting vascular endothelial growth factor or inducing HPV-specific immunity, has been gaining traction in RRP treatment 5.
- Further research is needed to explore the potential use of upadacitinib or other biologics in the treatment of RRP.
Future Directions in RRP Treatment
- Multi-center trials are required to fully characterize the potential use of various treatment options, including biologics and immunotherapy, in the management of RRP 3, 6.
- The development of new treatment strategies, including the use of therapeutic vaccines and immunotherapy, holds promise for improving outcomes in RRP patients 2, 3, 4, 5, 6.