Search

A comparative placebo-controlled trial involving 419 adults showed that a one-week course of famciclovir started within 3 days of onset of skin lesions had no effect on the acute phase of zoster, the time required for scabs to fall, the end of skin lesion progression, or pain. In this trial famciclovir failed to reduce the incidence of post-zoster pain, but it did reduce its median duration by approximately 2 months. According to a subgroup analysis (not planned for by the protocol), only patients over 50 benefited from this effect. Three other trials suggest that the approved dose regimen in France (500 mg 3 times a day) may not be optimal. The dose recommended in the United Kingdom (750 mg in one daily intake or 250 mg 3 times a day) seems to be more in line with the clinical assessment file. The three available comparative trials show no statistically significant difference between famciclovir and aciclovir in terms of efficacy or tolerability. An indirect comparison suggests that the risk-benefit ratio of famciclovir and valaciclovir are probably similar. However, the effects of famciclovir on post-zoster pain were observed in a clinical trial, while those of aciclovir were found only in meta-analyses.

Objective: To determine the efficacy of high-dose oral acyclovir in preventing cytomegalovirus (CMV) and other herpesvirus disease in patients with advanced HIV disease and to evaluate its effect on patient survival., Design: Double-blind, placebo-controlled randomized trial of up to 1 year's therapy., Setting: Outpatient clinics in 16 hospitals in Europe and Australia., Participants: A total of 302 patients with Centers for Disease Control and Prevention stage IV HIV disease, seropositive for CMV and with CD4+ lymphocyte counts < or = 150 x 10(6)/l., Interventions: Oral acyclovir (800 mg, four times daily) or matching placebo for 48 weeks., Main Outcome Measures: Time to development of CMV and other herpesvirus disease. Following the results of another study, the protocol was amended to make survival a second major endpoint., Results: Acyclovir failed to reduce the incidence of CMV disease: the probability of developing CMV disease at 1 year was 0.24 and 0.23 in the placebo and acyclovir groups, respectively (P = 0.53). However, acyclovir significantly reduced the probability of dying at 1 year of follow-up (from 0.39 to 0.23; P = 0.018). As expected, acyclovir significantly reduced the incidence and frequency of herpes simplex virus disease. There were no notable differences between treatment groups in clinically adverse experiences and no changes in haematological parameters to indicate clinically significant drug-induced toxicity., Conclusions: High-dose acyclovir failed to reduce the incidence of CMV disease, but significantly reduced the probability of dying at 1 year of follow-up.

In a multicenter study, the efficacy of oral acyclovir 800 mg daily in preventing the development of recurrent herpes simplex virus lesions in 379 patients was assessed. Medication given in two or four divided doses daily for one year was highly effective and well tolerated. A high therapeutic index of acyclovir was maintained throughout the period of study.