Treatment of Adult Varicella with Sorivudine: A Randomized, Placebo-Controlled Trial

Wallace, Mark R.; Chamberlin, Carolyn J.; Sawyer, Mark H.; Arvin, Ann M.; Harkins, J. D.; LaRocco, Anthony; Colopy, Mike W.; Bowler, William A.; Oldfield, Edward C.

doi:10.1093/infdis/174.2.249

Cited by 28 publications

(7 citation statements)

References 19 publications

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“…in a dose of 10 or 40 mg once a day for 5 days, shortened the mean time of cutaneous crusting and cessation of new lesion formation. Unlike ACV, the effectiveness of sorivudine was not affected by the duration of the rash before the onset of the therapy (21).…”

Section: Management Of Chickenpoxmentioning

confidence: 90%

Varicella zoster virus: review of its management

Mustafa

Arduino

Porter

2009

J Oral Pathology Medicine

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Varicella zoster virus (VZV) is one of eight herpes viruses known to infect humans. Primary infection causes varicella (chickenpox), after which virus becomes latent. Years later, VZV reactivates and causes a wide range of neurological diseases. The aim of the present report was to critically examine the published literature to evaluate advantages and limitations of therapy of VZV infection in both immunocompetent and immunocompromised patients. Aciclovir (ACV) has been the drug of choice for many years for the treatment of VZV infections. Recently, other antiviral agents have been developed to overcome the low oral bioavailability of ACV, as well as to provide a more flattering dosage regime. Chickenpox is a benign self-limiting disease in the majority of cases and usually no specific treatment is required. Treatment of shingles is indicated to reduce the acute symptoms of pain and malaise, to limit the spread and duration of the skin lesions and to prevent the development of post-herpetic neuralgia. Different classes of drugs have been used for the treatment of post-herpetic neuralgia. The first choice of any of these medications should be guided by the patient's medical health, the likely adverse effects of the drug and the patient's preference.

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Section: Management Of Chickenpoxmentioning

confidence: 90%

Varicella zoster virus: review of its management

Mustafa

Arduino

Porter

2009

J Oral Pathology Medicine

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“…The efficacy of famciclovir and valacyclovir for varicella has not been evaluated in healthy or immunocompromised patients. BVaraU (sorivudine), given as a single dose of 40 mg/ day for 5 days, is being studied in otherwise healthy young adults with varicella (251). The initial data analysis indicates that the drug reduces fever, the time to cessation of new-lesion formation, the time to complete crusting, and the total number of cutaneous lesions compared with placebo and that efficacy can be documented even when treatment is not initiated until 24 to 96 h after onset of the rash (251).…”

Section: Varicellamentioning

confidence: 99%

Varicella-zoster virus

1996

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Varicella-zoster virus (VZV) is a ubiquitous human alphaherpesvirus that causes varicella (chicken pox) and herpes zoster (shingles). Varicella is a common childhood illness, characterized by fever, viremia, and scattered vesicular lesions of the skin. As is characteristic of the alphaherpesviruses, VZV establishes latency in cells of the dorsal root ganglia. Herpes zoster, caused by VZV reactivation, is a localized, painful, vesicular rash involving one or adjacent dermatomes. The incidence of herpes zoster increases with age or immunosuppression. The VZV virion consists of a nucleocapsid surrounding a core that contains the linear, double-stranded DNA genome; a protein tegument separates the capsid from the lipid envelope, which incorporates the major viral glycoproteins. VZV is found in a worldwide geographic distribution but is more prevalent in temperate climates. Primary VZV infection elicits immunoglobulin G (IgG), IgM, and IgA antibodies, which bind to many classes of viral proteins. Virus-specific cellular immunity is critical for controlling viral replication in healthy and immunocompromised patients with primary or recurrent VZV infections. Rapid laboratory confirmation of the diagnosis of varicella or herpes zoster, which can be accomplished by detecting viral proteins or DNA, is important to determine the need for antiviral therapy. Acyclovir is licensed for treatment of varicella and herpes zoster, and acyclovir, valacyclovir, and famciclovir are approved for herpes zoster. Passive antibody prophylaxis with varicella-zoster immune globulin is indicated for susceptible high-risk patients exposed to varicella. A live attenuated varicella vaccine (Oka/Merck strain) is now recommended for routine childhood immunization.

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“…Twenty-four hours after a 40-mg dose, the sorivudine serum levels are still more than tenfold higher than the effective dose against VZV [25], These favourable pharmacokinetics permit once-a-day oral dosing.…”

Section: Sorivudinementioning

confidence: 99%

“…For the treatment of adult varicella, sorivudine has been tested in a randomized, placebo-controlled trial [25], Treatment with sorivudine, 40 mg once daily for 5 days, shortened the time to crusting from 6.6 to 5.8 days and reduced mean time to new lesion formation from 3.9 to 3.1 days. The effectiveness of therapy was not affected by the duration of rash before treatment was initiated.…”

Section: Varicellamentioning

confidence: 99%

Antiviral Therapy of Herpes simplex and Varicella-zoster Virus Infections

Wutzler¹

1997

Intervirology

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Antiviral treatment of herpesvirus infections is rapidly changing since the advent of new drugs with improved oral availability. The efficacy of valaciclovir, the prodrug of aciclovir, and famciclovir, the prodrug of penciclovir, in the treatment of herpes genitalis and acute herpes zoster has been well documented in large clinical trials. Both drugs are effective on zoster-associated pain. Brivudin and sorivudine which are the most active compounds against varicella-zoster virus (VZV) in cell culture have also been successful in the treatment of herpes zoster. Aciclovir is still the standard therapy of severe herpes simplex virus (HSV) and varicella virus infections. In patients treated with aciclovir, the mortality of herpes encephalitis has been reduced to about 25%. The development of resistance against aciclovir and the other nucleoside analogues has not been a problem to date in the treatment of immunocompetent individuals. However, in immunocompromised patients, aciclovir-resistant HSV strains often emerge. In such cases, intravenous foscarnet is the current treatment of choice.

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Treatment of Adult Varicella with Sorivudine: A Randomized, Placebo-Controlled Trial

Cited by 28 publications

References 19 publications

Varicella zoster virus: review of its management

Varicella zoster virus: review of its management

Varicella-zoster virus

Antiviral Therapy of Herpes simplex and Varicella-zoster Virus Infections

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