A meta-analysis to assess the efficacy of oral antiviral treatment to prevent genital herpes outbreaks - 19/08/11

Doi : 10.1016/j.jaad.2007.02.008

Bénédicte Lebrun-Vignes, MD ^a,^⁎ , Anissa Bouzamondo, PhD ^a, Alain Dupuy, MD ^b, Jean-Claude Guillaume, MD ^c, Philippe Lechat, MD, PhD ^d, Olivier Chosidow, MD, PhD ^e
^a From the Department of Pharmacology, Hôpital Pitié–Salpêtrière
^b Department of Dermatology, Hôpital Saint-Louis, Assistance Publique–Hôpitaux de Paris
^c Department of Dermatology, Hôpital Pasteur, Colmar
^d Department of Pharmacology, Hôpital Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris
^e Department of Dermatology and Allergology, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Université Pierre-et-Marie-Curie Paris VI

Reprint requests: Bénédicte Lebrun-Vignes, Department of Pharmacology, Hôpital Pitié–Salpêtrière, 47–83, boulevard de l’Hôpital, 75651 Paris Cedex 13, France.

Paris and Colmar, France

Abstract

Background

Efficacy of oral antiviral therapies, ie, acyclovir, valacyclovir (VACV), and famciclovir, for suppression of recurrent genital herpes was studied at different doses and regimens.

Objective

We sought to compare the clinical efficacies of the different oral antiviral drugs prescribed prophylactically to suppress recurrent genital herpes.

Methods

MEDLINE and EMBASE databases were searched for articles on genital herpes and selected antiviral drugs. The selected trials were: parallel randomized clinical trials testing prophylactic oral antiviral treatment of genital herpes versus placebo in immunocompetent and nonpregnant patients.

Results

Fourteen randomized clinical trials were selected, including a total of 6158 patients. The global relative risk of developing at least one recurrence during the study was reduced by 47% (95% confidence interval 45%-49%) in antiviral drug groups compared with the placebo. The best evaluated regimens, with comparable efficacies, were given twice daily, ie, acyclovir (400 mg twice daily), VACV (250 mg twice daily), and famciclovir (250 mg twice daily), or once daily (VACV 500 mg).

Limitations

The only end point available for all the studies was the number of patients presenting at least one recurrence of genital herpes during the observation period.

Conclusion

The results of this first meta-analysis confirmed the high clinical efficacy of oral acyclovir, VACV, or famciclovir for prophylaxis against recurrent genital herpes.

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Abbreviations used : ACV, CI, FCV, HSV, RCT, RR, VACV

Plan

Methods

Trial search strategy

Funding sources: None.
Disclosure: Olivier Chosidow is a consultant for GSK. Drs Lebrun-Vignes, Bouzamondo, Dupuy, Guillaume, and Lechat have no conflicts of interest to declare.