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Efficacy and Cost-Comparison of Herpes Zoster Ophthalmicus Treatment
TAKE-HOME MESSAGE
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This systematic review of three randomized clinical trials considering the treatment of herpes zoster ophthalmicus concluded that oral famciclovir and valacyclovir are as effective as oral acyclovir for the treatment of this active condition.
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Additionally, due to the differences in dosing, oral famciclovir and valacyclovir offer a cost savings in Canada.
– Kathleen Freeman, OD, FAAO
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersObjective
A systematic review and cost comparison were conducted to determine the optimal treatment of active herpes zoster ophthalmicus (HZO) in immunocompetent adults.
Design
A literature search of MEDLINE, EMBASE, CINAHL, Cochrane Library, BIOSIS Previews and Web of Science, ClinicalTrials.gov, International Clinical Trials Registry Platform, Networked Digital Library of Theses and Dissertations, and Canadian Health Research Collection was performed. The search period was from January 1990 to March 2017.
Participants
Collectively, 516 immunocompetent patients with active HZO treated with oral antivirals were included.
Methods
Randomized controlled trials (RCTs) investigating treatment of active HZO in immunocompetent adults, with one oral acyclovir monotherapy arm, were included. Studies fulfilling inclusion criteria were subjected to quality assessment and data extraction. Provincial drug formularies were consulted to extrapolate cost comparison for investigated treatment regimens.
Results
A total of 1515 titles and abstracts and 9 full-text articles were assessed. Three RCTs met the inclusion criteria. Treatment with oral acyclovir (800 mg 5 times daily for 10 days) was superior to placebo in the prevention of ocular manifestations. Oral famciclovir (500 mg 3 times daily for 7 days) and valacyclovir (1000 mg 3 times daily for 7 days) resulted in comparable rates of ocular manifestations relative to oral acyclovir (800 mg 5 times daily for 7 days). According to provincial drug formulary data, famciclovir and valacyclovir are more affordable across Canada with the recommended dosing schedules.
Conclusions
Oral famciclovir and valacyclovir are reasonable alternatives to oral acyclovir for treatment of active HZO in immunocompetent individuals. Their simpler dosing schedules are associated with a cost benefit that is consistent across Canada.
A variety of ocular complications are associated with an active herpes zoster (HZ) infection. Early diagnosis and treatment with antiviral medication reduce the duration, severity, and the potential of visual disability. A variety of antiviral medications exist. A systematic review was performed to determine if the newer antiviral agents in the class were associated with improvements in outcomes and/or reduced ocular complications in immunocompetent adults. A cost comparison of the existing regimens was also performed. Oral famciclovir and valacyclovir were found to be reasonable alternatives to acyclovir with simpler dosing schedules and a cost benefit that was consistent across Canada.