Antivirals for Management of Herpes Zoster Including Ophthalmicus: A Systematic Review of High-Quality Randomized Controlled Trials

McDonald, Elissa M; Kock, Johannes de; Ram, Felix S F

doi:10.3851/imp2011

Cited by 53 publications

(34 citation statements)

References 24 publications

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“…[10][11][12][13] Antiviral therapy can reduce the duration of herpes zoster rash but has not been shown to decrease the incidence of postherpetic neuralgia. [14][15][16][17] Vaccination is therefore an attractive option to reduce the disease burden due to herpes zoster and its complications in older adults. Currently, a live attenuated herpes zoster vaccine (Zostavax, Merck) is approved for use in adults 50 years of age or older and is recommended for adults 60 years of age or older.…”

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confidence: 99%

Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older

Lal²,

et al. 2016

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BACKGROUNDA trial involving adults 50 years of age or older showed that the herpes zoster subunit vaccine (HZ/su) containing recombinant varicella-zoster virus glycoprotein E and the AS01 B adjuvant system was associated with a risk of herpes zoster that was 97.2% lower than that associated with placebo. A second trial was performed concurrently at the same sites and examined the safety and efficacy of HZ/su in adults 70 years of age or older . METHODSThis randomized, placebo-controlled, phase 3 trial was conducted in 18 countries and involved adults 70 years of age or older. Participants received two doses of HZ/su or placebo (assigned in a 1:1 ratio) administered intramuscularly 2 months apart. Vaccine efficacy against herpes zoster and postherpetic neuralgia was assessed in participants from ZOE-70 and in participants pooled from ZOE-70 and ZOE-50. RESULTSIn ZOE-70, 13,900 participants who could be evaluated (mean age, 75.6 years) received either HZ/su (6950 participants) or placebo (6950 participants). During a mean follow-up period of 3.7 years, herpes zoster occurred in 23 HZ/su recipients and in 223 placebo recipients (0.9 vs. 9.2 per 1000 person-years). Vaccine efficacy against herpes zoster was 89.8% (95% confidence interval [CI], 84.2 to 93.7; P<0.001) and was similar in participants 70 to 79 years of age (90.0%) and participants 80 years of age or older (89.1%). In pooled analyses of data from participants 70 years of age or older in ZOE-50 and ZOE-70 (16,596 participants), vaccine efficacy against herpes zoster was 91.3% (95% CI, 86.8 to 94.5; P<0.001), and vaccine efficacy against postherpetic neuralgia was 88.8% (95% CI, 68.7 to 97.1; P<0.001). Solicited reports of injection-site and systemic reactions within 7 days after injection were more frequent among HZ/su recipients than among placebo recipients (79.0% vs. 29.5%). Serious adverse events, potential immune-mediated diseases, and deaths occurred with similar frequencies in the two study groups. CONCLUSIONSIn our trial, HZ/su was found to reduce the risks of herpes zoster and postherpetic neuralgia among adults 70 years of age or older. ( 1020T h e ne w e ngl a nd jou r na l o f m e dicine H erpes zoster, or shingles, results from the reactivation of latent varicellazoster virus (VZV) and typically manifests as a vesicular, painful dermatomal rash.

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confidence: 99%

Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older

Lal²,

et al. 2016

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“…For example, valinyl and acetyl ester prodrugs improved the oral absorption of acyclovir (prodrug valacyclovir hydrochloride) and penciclovir (prodrug famciclovir) by 15-70% [17][18][19][20], making these agents useful for oral treatment of herpes zoster infections ( Fig. 1) [21]. The metabolism of famciclovir to penciclovir in the liver is catalyzed by aldehyde oxidase and other enzymes [22][23][24][25].…”

Section: Key Pointsmentioning

confidence: 99%

Prodrug strategies for improved efficacy of nucleoside antiviral inhibitors

Hurwitz

Schinazi

2013

Current Opinion in HIV and AIDS

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Prodrug strategies can address the issues of poor oral bioavailability and delivery of active metabolites to the targeted cells. Additionally, NAPs demonstrate potential for improving deficiencies in oral absorption, metabolism, tissue distribution, cellular accumulation, phosphorylation, and overall potency, in addition to diminishing potential for in-vivo selection of resistant viruses. NAPs continue to be the backbone for the treatment of HIV and HBV, herpesviruses, and adenovirus infections because their active forms are potent, have long intracellular half-lives and are relatively safe with high barrier to resistance.

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“…Oral brivudin is available in some European countries and VZV is more sensitive to brivudin than to other antivirals. As mentioned above, valaciclovir or famciclovir, rather than acyclovir, are preferred due to their higher bioavailability and easier dosing regimen; furthermore, they may be more effective than acyclovir for reducing acute zoster pain 181,182 . Treatment is usually given for 7-10 days and reduces the time to cessation of new lesion formation, to lesion crusting and to cessation of acute pain 183 .…”

Section: Zoster and Phnmentioning

confidence: 99%