Evidence-Based Management of Head and Neck Vascular Anomalies by Jonathan A. Perkins & Karthik Balakrishnan

Author:Jonathan A. Perkins & Karthik Balakrishnan
Language: eng
Format: epub
ISBN: 9783319923062
Publisher: Springer International Publishing

Pharmacologic Additives to PDL Therapy

Recently, promising data has emerged from studies investigating the addition of various topical medications to a PDL treatment strategy. The most notable of these additives is rapamycin, an immunosuppressive mTOR (mammalian target of rapamycin) inhibitor thought to have anti-angiogenic properties. A phase II, randomized, double-blind, intraindividual placebo-controlled trial from 2015 demonstrated that topical rapamycin + PDL therapy was superior to all other arms (placebo alone, PDL + placebo, and rapamycin alone) in terms of photographic scoring and histological analysis [42]. This result is supported by a histological study in hamsters demonstrating decreased reperfusion rates in vessels treated with PDL + rapamycin compared to PDL alone [43]. Since the advent of PDL treatments, the use of adjuvant rapamycin is the most significant recent addition to the armamentarium. It is used topically as a 10% preparation in a liposomal base two times per day for months.

Imiquimod is another immunosuppressive molecule that reduces angiogenesis via a variety of mechanisms [44] which has demonstrated improved clearance when combined with PDL therapy [7, 45]. Conversely, a multicenter trial investigating similar use of the nonselective beta-blocker timolol failed to demonstrate improved clearance relative to PDL alone [46].

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