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Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older.

AbstractOBJECTIVE:
To compare the efficacy and safety of valacyclovir hydrochloride and famciclovir for the treatment of herpes zoster.
DESIGN:
A double-blind, randomized, controlled, multicenter clinical trial in which patients received 7 days of treatment and were followed up for 24 weeks.
SETTINGS:
Patients reported directly to specialist centers or were referred from primary care centers.
PATIENTS:
There were 597 otherwise healthy immunocompetent outpatients, aged 50 years and older, who presented within 72 hours of onset of zoster rash.
INTERVENTIONS:
Treatment with valacyclovir hydrochloride (1 g 3 times daily) or famciclovir (500 mg 3 times daily) for 7 days.
MAIN OUTCOME MEASURES:
Resolution of zoster-associated pain and postherpetic neuralgia, rash healing, and treatment safety.
RESULTS:
Intent-to-treat analysis did not detect statistically significant differences for valacyclovir vs famciclovir on resolution of zoster-associated pain (hazard ratio, 1. 02; 95% confidence interval, 0.84-1.23; P =.84). Furthermore, no differences were evident between treatments on rash healing rates and on a range of analyses of postherpetic neuralgia. Safety profiles for valacyclovir and famciclovir were similar, with headache and nausea being the more common adverse events.
CONCLUSIONS:
Valacyclovir treatment is comparable to famciclovir treatment in speeding the resolution of zoster-associated pain and postherpetic neuralgia. Current wholesale prices indicate that valacyclovir is the more cost-effective treatment for herpes zoster ($83.90 vs $140.70 per course).
AuthorsS K Tyring, K R Beutner, B A Tucker, W C Anderson, R J Crooks
JournalArchives of family medicine (Arch Fam Med) 2000 Sep-Oct Vol. 9 Issue 9 Pg. 863-9 ISSN: 1063-3987 [Print] UNITED STATES
PMID11031393 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Antiviral Agents
  • famciclovir
  • 2-Aminopurine
  • Valine
  • valacyclovir
  • Acyclovir
Topics
  • 2-Aminopurine (analogs & derivatives, economics, therapeutic use)
  • Acyclovir (analogs & derivatives, economics, therapeutic use)
  • Aged
  • Antiviral Agents (economics, therapeutic use)
  • Cost-Benefit Analysis
  • Double-Blind Method
  • Female
  • Herpes Zoster (drug therapy)
  • Humans
  • Male
  • Middle Aged
  • Neuralgia (etiology, prevention & control)
  • Pain (etiology, prevention & control)
  • Proportional Hazards Models
  • Time Factors
  • Valine (analogs & derivatives, economics, therapeutic use)

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