Update on Gardasil Vaccination in Recurrent Respiratory Papillomatosis Patients Aged 45 or Older.

Objective: Gardasil vaccination has been effective as primary prevention and adjuvant therapy for recurrent respiratory papillomatosis (RRP). We present an update to our previous research reporting a significant increase in the intersurgical interval (ISI) after adjuvant Gardasil vaccination. Our objectives were: (1) to assess the durability of Gardasil as an adjuvant in RRP with longer-term follow-up and an expanded cohort, and (2) to better control for the use of other non-Gardasil adjuvant therapies.

Methods: A retrospective chart review of adult patients > 45 years diagnosed with RRP from 2008 to 2022 was conducted. Patients were considered vaccinated if they received at least two Gardasil doses.

Results: There were 51 total patients, 14 vaccinated and 37 unvaccinated. There was a significant increase in the ISI for the vaccinated group from 126 to 304 days (p = 0.0039), with 100.1 ± 47.3 months follow-up. Our previous study, performed at 49.7 ± 30.3 months follow-up, found an ISI of 494 days in the vaccinated group. Non-Gardasil adjuvant use was greater in the vaccinated group, but we found no significant effect of non-Gardasil adjuvant use on ISI in the unvaccinated group (p = 0.34).

Conclusions: Adjuvant Gardasil use in RRP patients > 45 years significantly increases the ISI, which supports findings from our previous study. However, the magnitude of this effect may wane with time, with the ISI remaining significant but downtrending from 494 to 304 days. This data raise the question of whether booster Gardasil dosing warrants investigation.