5PSQ-130 Off-label use of cidofovir intralesional injections in extensive anogenital condylomatosis: a case report

• Published in: European journal of hospital pharmacy. Science and practice Vol. 30; no. Suppl 1; pp. A222 - A223
• Main Authors: Lora, S, Mejías Trueba, M, Herrera Hidalgo, L, Guisado Gil, AB, Rodríguez De FRANCISCO, L, Roca Oporto, C, Paniagua García, M, Álvarez Marín, R, Gil Navarro, MV
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 01-03-2023; BMJ Publishing Group LTD
• Subjects: Case reports; Conflicts of interest; Human papillomavirus; Late breaking abstracts
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2023-eahp.460

Background and ImportanceGenital warts caused by human papillomavirus (HPV) in condylomatosis often show a variable response to recommended therapies, especially in immunocompromised patients. New alternatives to improve their approach are needed.Aim and ObjectivesTo describe the effectiveness, safety, and preparation of cidofovir intralesional injections (ILI) for the treatment of HPV condylomatosis in an immunocompromised patient.Material and MethodsWe describe the case of a 33-year-old woman with a giant perianal condylomata accuminata (affecting the clitoris, labia majora and minora, vagina, anal canal and both nalgae). She was initially immunocompromised due to a renal transplant (no renal graft at the starting of cidofovir) and a late-detected common variable immunodeficiency. Condylomatosis precipitated several episodes of bacterial cellulitis. The patient had been previously treated with liquid nitrogen, podophyllotoxin, imiquimod 5%, sinecatechins and 5-fluorouracil, obtaining no response.Off label treatment with monthly cidofovir ILIs for cytoreductive purposes was proposed and approved. Response to cidofovir ILIs was assessed by reduction in both the number and size of anogenital warts.ResultsCidofovir ILIs were prepared by diluting a vial of cidofovir 375 mg in 60 ml of 0.9% sodium chloride, obtaining a final concentration of 6.25 mg/ml. Of these 60 ml, 5 syringes of 12 ml were loaded (75 mg of cidofovir in each one), which have a stability of 5 months refrigerated (2–8°C), according previous studies.Intralesional cidofovir treatment started in February 2022. After three drug administrations, a significant improvement in lesions was described by a reduction in both their volume and extension. A bad odor of superficial exudate was also reported, which was solved with first polymyxin and later fusidic acid, both administered topically, twice a day. The patient presented good tolerance to injections, only requiring local anesthesia with lidocaine for pain.Conclusion and RelevanceThis is the first case of use of this formulation of cidofovir ILIs in a patient with anogenital condylomatosis and immune deficiency. Previously, it was used in other manifestations of HPV infection. The formulation also proved to be stable, well-tolerated, and easy to prepare. Therefore, this therapy may be considered a reasonable option for the treatment of HVP condylomatosis when other treatments seem ineffective.References and/or AcknowledgementsConflict of InterestNo conflict of interest