Patient-initiated, twice-daily oral famciclovir for early recurrent genital herpes. A randomized, double-blind multicenter trial. Canadian Famciclovir Study Group

Sl, Sacks; Fy, Aoki; Díaz‐Mitoma, Francisco; Sellors, John; Shafran, SD

doi:10.1001/jama.276.1.44

Cited by 79 publications

(72 citation statements)

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“…Clinical indications for oral acyclovir, valaciclovir, and famciclovir include treatment of first episodes of genital HSV infection (11,49), recurrent genital HSV infection (63,65), herpes zoster (6,21), and suppressive therapy to prevent recurrences of genital HSV (22,91). Since mucocutaneous herpesvirus infections in immunocompromised patients can be severe and prolonged, oral therapy with acyclovir, valaciclovir, or famciclovir is usually indicated.…”

Section: Clinical Usagementioning

confidence: 99%

Herpes Simplex Virus Resistance to Acyclovir and Penciclovir after Two Decades of Antiviral Therapy

et al. 2003

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Acyclovir, penciclovir, and their prodrugs have been widely used during the past two decades for the treatment of herpesvirus infections. In spite of the distribution of over 2.3 × 106 kg of these nucleoside analogues, the prevalence of acyclovir resistance in herpes simplex virus isolates from immunocompetent hosts has remained stable at approximately 0.3%. In immuncompromised patients, in whom the risk for developing resistance is much greater, the prevalence of resistant virus has also remained stable but at a higher level, typically 4 to 7%. These observations are examined in the light of characteristics of the virus, the drugs, and host factors

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Section: Clinical Usagementioning

confidence: 99%

Herpes Simplex Virus Resistance to Acyclovir and Penciclovir after Two Decades of Antiviral Therapy

et al. 2003

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“…In addition to acyclovir, valacyclovir and famciclovir are the other oral agents approved for treatment of recurrent genital herpes. All three drugs have similar effi cacy in the treatment of genital herpes and have been shown to expedite lesion healing time by approximately 1-2 days when compared with placebo (Sacks et al 1996;Tyring et al 1998;Chosidow et al 2001). Their differences are revealed in their pharmacokinetic properties, which dictate their dosing schedules.…”

Section: Oral Agentsmentioning

confidence: 99%

Single-day treatment for orolabial and genital herpes: a brief review of pathogenesis and pharmacology

Tyring¹

2008

TCRM

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Herpes simplex virus (HSV) infection is a highly prevalent condition responsible for signifi cant morbidity and occasional mortality each year. Approximately half of all patients infected by HSV will experience at least one recurrence in their lifetime. For these recurrences, traditional therapy has included both suppressive and episodic treatment with nucleoside analogs. In regards to episodic treatment, 2-to 5-day oral regimens are best studied and most commonly reported. As with any medical condition having a well-understood mechanism of action and targeted treatment, therapeutic intervention is only as effective as allowed by patient compliance. Based on these concerns, recent studies have focused on shorter, less complicated, and more affordable options. This review delineates the evidence for single-day treatments of orolabial and genital herpes. Randomized, double-blind studies of both valacyclovir and famciclovir as single-day episodic therapy for HSV have been reported in the literature. Although no headto-head studies between the drugs have been performed, both regimens produced signifi cant improvement in healing time and symptom resolution over placebo. Single-day therapy for HSV infection is appealing for multiple reasons. First, it simplifi es the regimen, increasing likelihood of patient compliance. Additionally, it allows complete delivery of the medication at the onset of symptoms, when viral replication is highest and intervention has greatest effect. Lastly, the reduced number of pills necessary for single versus multiple day therapy decreases the overall cost of treatment per episode, an important factor in modern-day healthcare.

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“…Sacks et al (1996) reported the results of a randomized, double-blind, frequent observation, dose-ranging study comparing twice-daily famciclovir, 125 mg, 250 mg, or 500 mg with placebo. Patients initiated therapy after self-culturing from lesions, reported to the clinic within 12 h and were assessed twicedaily for at least 5 days.…”

Section: Mean Time (Days)mentioning

confidence: 99%

“…Studies with aciclovir have not demonstrated effects on symptoms such as itching or pain (Nilsen et al, 1982;Reichman et al, 1984). In contrast, valaciclovir has been shown to reduce the duration ofpain and episode duration, a measure of the time to cessation of all signs and symptoms (Spruance et al, 1996), whereas famciclovir has been shown to significantly reduce the duration of pain, tenderness and itching, as well as all patient symptoms (Sacks et al, Reproduced with permission (Sacks et al, 1996 …”

Section: Mean Time (Days)mentioning

confidence: 99%

The Value of Antivirals in Genital Herpes

Woolley¹

1997

Antivir Chem Chemother

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Although aciclovir has been the most extensively used nucleoside analogue for the treatment of genital herpes, its poor bioavailability, frequent dosing (five times daily), and the short intracellular half-life of the active triphosphate (≤1–2 h) has led to the development of a new generation of agents. The prodrug valaciclovir (active agent aciclovir), and famciclovir (active agent penciclovir) have improved pharmacokinetics compared with aciclovir. Compared with oral aciclovir, valaciclovir yields aciclovir with three-fivefold higher serum levels and the oral prodrug famciclovir yields even higher serum levels of penciclovir. The active agent, penciclovir triphosphate, has a prolonged intracellular half-life in vitro [10 h for cells infected with herpes simplex virus type 1 (HSV-1) and 20 h for HSV-2-infected cells]. Evidence also suggests that famciclovir may have an effect on the establishment of latency in primary infection, thus reducing the risk of subsequent recurrent disease. Ongoing clinical trials are underway exploring this possibility. For patients with frequent recurrences of genital herpes, or patients psychologically disabled by the condition, twice-daily antiviral therapy offers the most effective reduction in the frequency of clinical recurrence. Twice-daily therapy also has the advantage that patients are at less risk of asymptomatic breakthrough and the potential risk of transmission if they forget to take one dose.

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Patient-initiated, twice-daily oral famciclovir for early recurrent genital herpes. A randomized, double-blind multicenter trial. Canadian Famciclovir Study Group

Cited by 79 publications

References 0 publications

Herpes Simplex Virus Resistance to Acyclovir and Penciclovir after Two Decades of Antiviral Therapy

Herpes Simplex Virus Resistance to Acyclovir and Penciclovir after Two Decades of Antiviral Therapy

Single-day treatment for orolabial and genital herpes: a brief review of pathogenesis and pharmacology

The Value of Antivirals in Genital Herpes

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