Oral acyclovir in herpes zoster ophthalmicus

Harding, Simon; Porter, Susan M.

doi:10.3109/02713689109020376

Cited by 121 publications

(52 citation statements)

References 17 publications

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“…However, the methodology and patient age groups differ between trials, making comparisons difficult. Three of the studies showed an effect on the incidence of pain at 3 months compared with placebo (Huff, 1987;Harding et al, 1987; Morton & Thomson, 1989), but none showed an effect at 6 months ( Table 1). The largest study in the target population (i.e.…”

Section: Aciclovir Studiesmentioning

confidence: 99%

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Antiviral Therapy in Herpes Zoster: A Review

Marley

1997

Antivir Chem Chemother

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SummaryHerpes zoster is a disease caused by reactivation of the latent form of the varicella zoster virus (VZV). It is usually seen in adults, occurring mainly in the elderly. The acute phase of the disease is characterized by a rash, which is typically accompanied by pain. In some patients the pain may persist after the rash has healed, and may last for many months or years. Three antiviral agents are currently available to treat herpes zoster: aciclovir, its prodrug valaciclovir, and famciclovir. All three are effective in accelerating healing of the rash, and reducing the patient's period of infectivity. These antiviral agents also impact on the chronic pain associated with herpes zoster but appear to differ in their efficacy. Two different measures of chronic pain have been used in clinical studies: post-herpetic neuralgia (PHN) which refers to the pain occurring after the rash has healed, and zoster-associated pain (ZAP), defined as the continuum of pain occurring after the onset of herpes zoster [i.e. making no distinction between acute pain and PHN). Famciclovir has been shown to significantly reduce the risk and duration of PHN in patients over 50 years old. In another study famciclovir was shown to be significantly more effective than aciclovir in relieving ZAP when treatment was taken within 48 h of the onset of herpes zoster. Valaciclovir was also found to be better than aciclovir in reducing the duration of ZAP, but it is unclear whether this improvement over aciclovir also applied to PHN. Elderly patients therefore benefit from antiviral therapy, which should be initiated as early as possible, and can significantly reduce the risk and duration of the chronic pain associated with herpes zoster.

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Section: Aciclovir Studiesmentioning

confidence: 99%

“…Thus, only four studies investigated the currently recommended oral regimen of 800 mg five times daily (Huff, 1987;Harding et al, 1987;Morton & Thomson, 1989;McKendrick et al, 1996). All four investigated the effect of aciclovir on PHN.…”

Section: Aciclovir Studiesmentioning

confidence: 99%

Antiviral Therapy in Herpes Zoster: A Review

Marley

1997

Antivir Chem Chemother

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“…Studies in the immunocompromised showed, from an early date, that acyclovir was capable of preventing the life-threatening complication of visceral dissemination Balfour, McMonigal & Bean, 1983), and there is no case for further placebo-controlled trials in such patients (whether dissemination has already occurred or not). In the immunocompetent host, the efficacy of acyclovir upon pain was more contentious with individual studies producing inconclusive results (Huff et al, 1988(Huff et al, , 1993McKendrick, McGill & Wood, 1989;Morton & Thomson, 1989;Harding & Porter, 1991). A meta-analysis of three placebo-controlled studies of oral acyclovir (given at the standard dose of 800 mg five times daily for 7-10 days) in which the protocol required assessment of all patients (not just those who were still in pain) for a period of 6 months, has recently been reported (Wood et al, 1994a).…”

Section: Use Of Placebomentioning

confidence: 99%

How should zoster trials be conducted?

Balfour²,

Beutner³

et al. 1995

J Antimicrob Chemother

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In 1994, an international group of interested clinicians and biostatisticians met to discuss the design of clinical trials in herpes zoster. They agreed that trials in herpes zoster should have prospectively agreed definitions of all outcome measures and plans for data analysis. In immunocompetent individuals, in whom pain is the major outcome measure, trials should only include patients over the age of 50 years, and for those recruited within 72 h of rash onset, should be designed to demonstrate superiority of any new therapy over existing antivirals. The primary endpoint should be time to cessation of pain for at least 4 weeks and, for the purposes of statistical analysis of its duration, the pain associated with herpes zoster ought to be considered as a continuum. All other variables, including the incidence of post-herpetic neuralgia and effects upon quality of life should be considered as secondary end-points. Evaluation of treatment effects on primary endpoints should be based upon an intent-totreat (ITT) analysis and subgroup analysis should be used only to support the findings of the ITT analysis. These elements of good study design should be borne in mind in the evaluation of current and future trails of antiviral drugs in herpes zoster.

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“…Furthermore, given a list size of 2000, the average general practice may see from two to 10 cases of shingles per year, and may spend annually £200-£2000, a small proportion of their total practice drug budget. Therefore, the cost of ----------------------------- The extremes, bounded by the 'worst' trial result (Wood et al,1988) and the 'best' (Harding and Porter, 1991) single trial result, are from £334 to £5350 per case of PHN avoided.…”

Section: Management Issues In Herpes Zostermentioning

confidence: 99%

Treatment Parameters for the Successful Management of Varicella Zoster Virus

Nathwani

1995

Antivir Chem Chemother

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SummaryAntiviral therapy has an important role to play in the management of shingles. However, one needs to define clearly when the therapy is effective, who is likely to benefit from it, and whether or not its use can be justified from an economic point of view. Early medical consultation is of paramount importance if the clinical effectiveness arid economic benefits from antiviral therapy are to be optimized.

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Oral acyclovir in herpes zoster ophthalmicus

Cited by 121 publications

References 17 publications

Antiviral Therapy in Herpes Zoster: A Review

Antiviral Therapy in Herpes Zoster: A Review

How should zoster trials be conducted?

Treatment Parameters for the Successful Management of Varicella Zoster Virus

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