HPV vaccine could benefit cervical disease patients
MedWire News: Women who are diagnosed with precancerous cervical conditions after receiving the human papillomavirus (HPV) vaccine are at a significantly reduced risk for reoccurring disease, a BMJ study shows.
The authors say that although the vaccine does not prevent progression to disease in women who are infected with HPV at the time of vaccination, the HPV vaccine offers substantial benefit to women who develop HPV-related diseases afterwards.
Elmar Joura (Medical University of Vienna, Austria) and co-authors determined the effect of HPV quadrivalent vaccine on the risk for developing subsequent disease after surgery for cervical intraepithelial neoplasia or diagnosis of genital warts, vulvar intraepithelial neoplasia, or vaginal intraepithelial neoplasia.
The retrospective analysis included data from two international efficacy trials of quadrivalent HPV vaccine: protocol 013 (Females United To Unilaterally Reduce Endo/Ectocervical disease [FUTURE]) I and protocol 015 (FUTURE II).
Among 17,622 women aged 15-26 years who underwent 1:1 randomization to vaccine or placebo, 2054 underwent cervical surgery or were diagnosed with genital warts, vulvar intraepithelial neoplasia, or vagina intraepithelial neoplasia.
Women who received the vaccine were administered three doses of quadrivalent HPV vaccine or placebo at day 1, month 2, and month 6.
Among women who underwent cervical surgery after the trials, the risk for developing any subsequent HPV-related disease was 6.6 cases per 100 women per year among the 587 women who received the HPV vaccine. For the 763 women who received placebo, the risk was 12.2 cases per 100 women per year. This corresponded to a 46.2% reduced risk for any subsequent HPV-related disease in women who received the vaccine.
Vaccination was associated with a significant 64.9% reduction in risk for any subsequent high-grade disease of the cervix.
A total of 229 vaccine recipients and 475 placebo recipients were diagnosed with genital warts, vulvar intraepithelial neoplasia, or vagina intraepithelial neoplasia, and the incidence of any HPV-related disease in each group was 20.1 compared with 31.0 cases per 100 women per year, respectively.
This corresponded to a 35.2% reduction in any subsequent HPV-related disease after diagnosis and treatment for women with vaginal or vulvar disease, the authors note.
"Only long-term surveillance can determine the population effectiveness of vaccination. Several programmes to monitor both the safety and the impact of HPV vaccines on disease outcomes are in place," the authors suggest.
Kim adds: "As evidence of both the efficacy and effectiveness of HPV vaccination continues to emerge, clear communication of the remarkable yet complex properties of HPV vaccines - specifically information about where the evidence is clear and where it remains uncertain - is crucial."
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By Piriya Mahendra