Herpes Zoster trials

Herpes zoster infections There are no data on treatment initiated more than 72 hours after the onset of the rash. Initiate treatment as soon as possible after diagnosis. In clinical trials, treatment was most effective when started within the first 48 hours of rash onset. 

Arani RB, Soong S-1, Weiss HL, Wood Ml et al. (2001) Phase specific analysis of herpes zoster associated pain data a new statistical approach Statistics in Medicine, 20, 2429-2439 Bedikian AY, MiUward M, Pehamberger H, Conry R et al. (2006) Bcl-2 Antisense (obUmersen sodium) plus dacarbazine in patients with advanced melanoma The ObUmersen Melanoma Study Group Journal of Clinical Oncology, 24, 4738-4745 Bland M (2004) Cluster randomised trials in the medical Uterature two bibliometric surveys BMC Medical Research Methodology, 4, 21... 

Kaplan EL and Meier P (1958) Non-parametric estimation from incomplete observations Journal of the American Statistical Association, 53, 457-M81 Kaul S and Diamond GA (2006) Good enough a primer on the analysis and interpretation of non-inferiority trials Annals of Internal Medicine, 145, 62-69 Kay R (1995) Some fundamental statistical concepts in clinical trials and their application in herpes zoster Antiviral Chemistry and Chemotherapy, 6, Supplement 1, 28-33 Kay R (2004) An explanation of the hazard ratio Pharmaceutical Statistics, 3, 295-297... 

Three oral nucleoside analogs are licensed for the treatment of HSV and VZV infections acyclovir, valacyclovir, and famciclovir. They have similar mechanisms of action and similar indications for clinical use all are well tolerated. Acyclovir has been the most extensively studied it was licensed first and is the only one of the three that is available for intravenous use in the United States. Comparative trials have demonstrated similar efficacies of these three agents for the treatment of HSV but modest superiority of famciclovir and valacyclovir for the treatment of herpes zoster. Neither valacyclovir nor famciclovir has been fully evaluated in pediatric patients thus, neither is indicated for the treatment of varicella infection. 

Shafran SD, Tyring SK, Ashton R, et al. Once, twice, or three times daily famciclovir compared with aciclovir for the oral treatment of herpes zoster in immunocompetent adults a randomized, multicenter, double-blind clinical trial. J Clin Virol. 2004 29 248-253. 

Oral famciclovir is effective for the treatment of first and recurrent genital herpes attacks and for chronic daily suppression (Table 49-1). It is also used to treat acute herpes zoster (shingles). In controlled trials in immunocompetent patients with zoster, famciclovir was similar to acyclovir in rates of cutaneous healing but was associated with a shorter duration of postherpetic neuralgia. Comparison of famciclovir to valacyclovir for treatment of herpes zoster in immunocompetent patients showed similar rates of cutaneous healing and pain resolution. However, neither drug decreased the incidence of postherpetic neuralgia. 

There is no cure for SLE. Guillermo el al. (G16) found only 10 randomized controlled trials during the past 5 years, 5 for lupus nephritis and 5 for all SLE patients. Compared to conventional therapies for lupus nephritis, a monthly bolus with intravenous cyclophosphamide is more effective than a monthly bolus with methyl prednisolone, but has significant side effects (including amenorrhea, cervical dysplasia, avascular necrosis, and herpes zoster) in both groups (G14). In order to avoid these side effects, more recent therapies have been developed. However, neither plasmapheresis (Wl), intravenous immunoglobulin (B21), recombinant human DNase (rhDNase) (D3), nor mycophenolate mofetil (C14) was shown to be more effective than conventional therapy. However, some of these... 

A large, randomized, double-blind, multicenter trial compared the safety and efficacy of oral valacyclovir and oral acyclovir for treating herpes zoster in immunocompetent adults and concluded that treatment with valacyclovir was convenient, equivalent in safety to acyclovir, accelerated the resolution of zoster-associated pain and postherpetic neuralgia, and reduced the number of patients with pain lasting > 6 months (Beutner et al.). 

Marsh RJ, Cooper M. Double-masked trial of topical acyclovir and steroids in the treatment of herpes zoster ocular inflammation. BrJ Ophthalmol 1991 75(9) 542-546. 

Shen M, Lin H, Lee SS, et al. Double-blind, randomized, acyclovir-controUed, parallel-group trial comparing the safety and efficacy of famciclovir and acyclovir in patients with uncomplicated herpes zoster. J Microbiol Immunol Infect 2004 37 75-81. 

Tyring S, Belanger R, Bezwoda W, et al. A randomized, doubleblind trial of famciclovir versus acyclovir for the treatment of localized dermatomal herpes zoster in immunocompromised patients. Cancer Invest 2001 19(l) 13-22. 

Tyring S, Barbarash Ra, Nahlik JE, et al. Famciclovir for the treatment of acute herpes zoster. Effects on acute disease and postherpetic neuralgia a randomized, double-blind, placebo-controUed trial.Ann Intern Med 1995 123(2) 89-96. 

Tyring SK, Beutner KR, Tucker BA, et al. Antiviral therapy for herpes zoster. Randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Earn Med 2000 9 863-869. 

Wood MJ,Johnson RW, McKendrick MW, et al. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med 1994 330(13) 896-900. 

Dworkin RH, Barbano RL, T5fring SK, Betts RF, McDermott MP, Pennella-Vaughan J, Bennett GJ, Berber E, Gnann JW, Irvine C, Kamp C, Kieburtz K, Max MB, Schmader KE. A randomized, placebo-controlled trial of oxycodone and of gabapentin for acute pain in herpes zoster. Pain 2009 142(3) 209-17. 

In a randomised, double-blind controlled trial, 373 immxmocompetent adults with onset of a herpes zoster rash within the preceding 72 h were assigned to receive seven days of valomaciclovir at one of three doses or valaciclovir Ig three times daily [49 -]. Nausea (10% of patients receiving valaciclovir), headache (7%) and vomiting (3%) were reported. One patient in the valaciclovir group discontinued due to severe abdominal cramps. 

Tyring SK, Plunkett S, Scribner AR, Broker RE, Herrod JN, Handke LT, et al. Valmaciclovir Zoster Study Group. Valomaciclovir versus valacyclovir for the treatment of acute herpes zoster in immunocompetent adults a randomized, double-blind, active-controlled trial. J Med Virol 2012 84(8) 1224-32. 

Simpson, J.R. (1975) Clinical trials Idoxur-idine in the treatment of herpes zoster. Practitioner, 215, 226. 

---