Comparison between famciclovir and valacyclovir for acute pain in adult Japanese immunocompetent patients with herpes zoster

Abstract

Famciclovir is a guanine analog antiviral drug used commonly for herpes zoster. Efficacy of famciclovir treatment has been reported to be comparable to valacyclovir treatment. Both of these medications reduce the time to complete cessation of zoster-associated pain including post-herpetic neuralgia, as compared to acyclovir. We conducted a multicenter, randomized, open clinical trial in order to evaluate the extent of pain relief afforded by these two antiviral drugs during the acute disease phase of herpes zoster. The study group comprised 86 immunocompetent adult patients suffering from herpes zoster, who were treated with either famciclovir or valacyclovir for 7 days. Of these, 55 patients enrolled in this study within 72 h of the onset of the rash and 31 patients after 72 h of the onset. There was a significant reduction in acute herpes zoster pain with famciclovir on day 7 and at 2-3 weeks in both of these patient groups, while with valacyclovir, there was not significant reduction in pain on day 7. Of patients aged 50 years or older, there was a significantly earlier reduction in pain with famciclovir than with valacyclovir. In addition, a significant reduction in the number of patients with pain was observed as early as days 3-4 with famciclovir treatment as compared with valacyclovir treatment. We conclude that famciclovir was superior to valacyclovir in the relief of acute pain of herpes zoster. Accordingly, famciclovir is recommended for herpes zoster patients with moderate symptoms and a visual analog scale score of under 50 mm.

Comparison of Famciclovir, Valaciclovir, and Brivudine Treatments in Adult Immunocompetent Patients With Herpes Zoster

“…Although a difference was not detected between drug groups in patients below 50 years of age, a significant reduction occurred in pain within the first 7 days in patients older than 50 years. 5 In our study, although FCV and VACV were both effective on pain, a significant difference was not detected between the 2 groups. A significant difference was not detected between the 2 groups with regard to their effectiveness on pain in mild and moderate HZ patients.…”

“…[1][2][3][4][5] The effectiveness of FCV, BRV, and VACV in acute HZ and HZ-related pain has been shown in placebo-controlled studies. 1,[6][7][8][9] Some studies have also compared the effectiveness of FCV-VACV and BRV-FCV in acute HZ.…”

“…Therefore, rapid and appropriate antiviral treatment is required to control AHP in the active periods, particularly in the elderly. 1,4,5 The treatment goals in HZ include rapid recovery, pain control, and reduced complication risks. Early commencement of antiviral treatment accelerates the recovery of rash while also reducing the severity of the disease and its attendant complications.…”

“…Famciclovir (FCV), valaciclovir (VACV), and brivudine (BRV) are preferred to aciclovir because they are more effective and are used in lower doses. [1][2][3][4][5] To the best of our knowledge, no previous studies attempted to make a simultaneous comparison of these 3 commonly used drugs. Thus, we aimed to retrospectively evaluate the effectiveness of famciclovir, valaciclovir, and brivudine on pain intensity in immunocompetent patients with acute HZ.…”

Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia

“…Treatment should begin within 72 h of the onset of symptoms and continue for 7 days [2, 6, 12]. Antiviral drugs have been reported to account for 50–70% of the drug cost for treated cases of HZ [13–16].…”