Antiviral Therapy for Herpes Zoster: Randomized, Controlled Clinical Trial of Valacyclovir and Famciclovir Therapy in Immunocompetent Patients 50 Years and Older

Tyring, Stephen K.; Beutner, Karl R.; Tucker, Budd A.; Anderson, W C; Crooks, R. J.

doi:10.1001/archfami.9.9.863

Cited by 202 publications

(90 citation statements)

References 18 publications

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“…However, our participants compared favourably with other study populations of patients with herpes zoster. 10,[33][34][35] Our results should thus be generalizable to patients seeking care for herpes zoster during the acute phase. Our data are also likely to present information bias such as learning effects because of repeated testing with the same instrument over time.…”

Section: Limitationsmentioning

confidence: 99%

The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study

Drolet¹,

Brisson²,

Schmader³

et al. 2010

Canadian Medical Association Journal

247

196

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H erpes zoster, which is characterized by dermatomal pain and vesicular rash, 1,2 results from reactivation of the varicella-zoster virus. 3,4 The average lifetime risk of herpes zoster in developed countries is estimated to be about 30% [5][6][7] and increases with increasing life expectancy. The most common complication of herpes zoster, and one of the most challenging to treat, is post herpetic neuralgia, a painful condition often defined as pain persisting for more than 90 days after rash onset.8 According to this definition, postherpetic neuralgia is estimated to occur in 8%-27% of people with herpes zoster overall.9-14 The risk of postherpetic neuralgia increases markedly with age. 15The Shingles Prevention Study, a randomized doubleblind placebo-controlled trial, showed that a live-attenuated varicella-zoster virus vaccine was safe and effective in preventing herpes zoster and postherpetic neuralgia among people 60 years of age and older.13 Given these promising results, policy-makers and clinicians are being asked to make recommendations regarding the use and funding of the herpes zoster vaccine. To do this, evidence on the burden of herpes zoster from the patient's perspective is required. The only data available on the impact of herpes zoster on health-related quality of life comes from two short-term studies.16,17 Clinical reports and cross-sectional surveys [18][19][20] have also suggested that post herpetic neuralgia can profoundly impair quality of life. However, no study followed a cohort of patients with newly diagnosed herpes zoster for a sufficient period to assess postherpetic neuralgia and describe the associated impact on quality of life.We undertook a multicentre prospective study to describe the impact of herpes zoster and postherpetic neuralgia on health-related quality of life.

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Section: Limitationsmentioning

confidence: 99%

The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study

Drolet¹,

Brisson²,

Schmader³

et al. 2010

Canadian Medical Association Journal

247

196

View full text Add to dashboard Cite

show abstract

“…A study highlighting the effi cacy of Zostavax revealed that cases of HZ were reduced by half in those who received the vaccine versus placebo. Participants who were vaccinated but still acquired HZ were 66% less likely to develop PHN than those given a placebo (18). Hence, the new HZ vaccine may reduce the incidence of HZ and its potential complications in patients with a heightened risk of developing the disease.…”

Section: Discussionmentioning

confidence: 99%

Vibrio Vulnificus Necrotizing Fasciitis Preceding Herpes Zoster

Ha¹,

Tyring²

2013

Baylor University Medical Center Proceedings

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A 74-year-old white man presented with unilateral radicular pain extending across the left side of his chest and back. A diagnosis of postherpetic neuralgia, a sequela of herpes zoster, was made. Herpes zoster represents a reactivation of the varicella zoster virus that lies dormant in patients with past chickenpox. Risk factors for the disease include advanced age, stress, immunodeficiency, and immunosuppression. Treatment of herpes zoster entails traditional antiviral medications, while prevention may be achieved with a new prophylactic vaccine.H erpes zoster (HZ), also known as varicella zoster or more colloquially as "shingles," is a neurodermal disease characterized by unilateral radicular pain, tingling, pruritus, and a characteristic vesicular rash set on an erythematous base. Th e rash entails a reactivation of the latent varicella zoster virus (VZV) that lies dormant in cranial or sensory nerve ganglia. Th e most commonly aff ected dermatomes lie in the cranial and thoracic regions of the body. Approximately 98% of the population remains susceptible to HZ, as the virus lies quiescent in individuals previously affl icted with chickenpox. Because of such widespread susceptibility, it is important to identify the risk factors that may predispose one to HZ. CASE REPORTA 74-year-old white man presented with a 10-month history of unilateral radicular pain extending across the left side of his chest and back in the region of the T5 dermatome; he rated this pain as a "10" on a 0-to 10-point scale. Th e patient revealed that his HZ outbreak had been preceded by necrotizing fasciitis, which resulted in several hemorrhagic bullae located along the left upper extremity (C6, C7, and C8) (Figure 1). Th e infection was induced by a puncture wound that arose while the patient was fi shing in the Gulf of Mexico. He was hospitalized for 1 week and treated with cefotaxime, ciprofl oxacin, and minocycline. Approximately 7 days following his discharge from the hospital, the hemorrhagic bullae had begun to resolve and painful vesicles in the adjacent T5 dermatome began to emerge. Th e patient was subsequently diagnosed with HZ and treated with famciclovir. Previously, he had type 2 diabetes mellitus treated with rosiglitazone. Examination revealed a hypopigmented scar that closely followed the course of pain along the indicated dermatome (Figure 2). Swelling and soreness were noted under the patient's left arm, making any voluntary movement of the arm extremely painful. Th ough the patient did not have a history of shingles, he affi rmed that his son, grandson, and brother had all been affl icted with the malady at various times. Th e patient remembered having had chickenpox as a child. DISCUSSIONAlthough most of the population remains susceptible to HZ after recovering from a bout of chickenpox, the lifetime risk is estimated at approximately 15% (1). Th is incidence, however, rises dramatically with age, aff ecting up to 50% of those ≥85 years. Advanced age represents the most potent risk factor for the development of HZ a...

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“…The oral antiviral agent valacyclovir (Valtrex; GlaxoSmithKline, Tokyo, Japan) has been approved in Japan for several indications, including treatment for herpes zoster and genital herpes. We used the worldwide-approved valacyclovir dosage of 1 g, three times daily (Tyring et al, 2000) in our clinical trial.…”

Section: Vector and Valacyclovirmentioning

confidence: 99%

Quality of Life of Patients with Hormone Refractory Prostate Cancer After Gene Therapy

Gotoh¹,

Terao²,

Shirakawa³

2011

Gene Therapy Applications

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Antiviral Therapy for Herpes Zoster: Randomized, Controlled Clinical Trial of Valacyclovir and Famciclovir Therapy in Immunocompetent Patients 50 Years and Older

Abstract: Valacyclovir treatment is comparable to famciclovir treatment in speeding the resolution of zoster-associated pain and postherpetic neuralgia. Current wholesale prices indicate that valacyclovir is the more cost-effective treatment for herpes zoster ($83.90 vs $140.70 per course).

Cited by 202 publications

References 18 publications

The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study

The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study

Vibrio Vulnificus Necrotizing Fasciitis Preceding Herpes Zoster

Quality of Life of Patients with Hormone Refractory Prostate Cancer After Gene Therapy

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