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Herpes Zoster Management in Immunocompetent Patients: Effectiveness of Antivirals 1.Elissa M McDonald¹ ¹University of Auckland, Auckland, New Zealand Purpose: Effectiveness of antivirals in the management of herpes zoster including ophthalmicus in immunocompetent patients: a systematic review and meta-analysis Methods: Twelve randomized controlled trials involving 7,277 patients were included. Trials compared one antiviral to another for a minimum of seven days (aciclovir, valaciclovir, famciclovir or brivudin) in immunocompetent patients presenting with herpes zoster diagnosed within 72 hours of symptom onset. Reduction in pain was the primary outcome. Results: Valaciclovir showed significant reduction in herpes zoster associated pain compared to aciclovir for time points between 1-112 days, with the largest risk reduction (36%) at 21-30 days (Relative Risk (RR) 0.64; 95%CI 0.59-0.70) with a number-need-to-treat (NNT) of 3. Famciclovir when compared to aciclovir also showed significant reduction in risk of pain (46%) at 28-30 days (RR 0.54; 95%CI 0.48-0.68; NNT 3). Time for lesion healing and adverse effect profiles for all three antivirals were comparable. Conclusions: Evidence from good quality trials comparing antivirals have shown greatest reduction in risk of pain with valaciclovir in the management of herpes zoster including ophthalmicus. Results of this review suggest that valaciclovir should be the preferred treatment for all patients with herpes zoster ophthalmicus. Furthermore, both valaciclovir and famciclovir should be the preferred treatment option in patients with herpes zoster as they provide significantly greater reduction in the risk of herpes zoster associated pain in addition to their superior pharmacokinetics and more convenient dosing regimens compared to aciclovir. Future studies should address the role of famciclovir in the management of patients with herpes zoster ophthalmicus. |
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