Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group.
OBJECTIVE
To document the effects of treatment with famciclovir on the acute signs and symptoms of herpes zoster and postherpetic neuralgia.


METHODS
A randomized, double-blind, placebo-controlled, multicenter trial.


METHODS
36 centers in the United States, Canada, and Australia.


METHODS
419 immunocompetent adults with uncomplicated herpes zoster.


METHODS
Patients were assigned within 72 hours of rash onset to famciclovir, 500 mg; famciclovir, 750 mg; or placebo, three times daily for 7 days.


METHODS
Lesions were assessed daily for as long as 14 days until full crusting occurred and then weekly until the lesions healed. Viral cultures were obtained daily while vesicles were present. Pain was assessed at each of the visits at which lesions were examined and then monthly for 5 months after the lesions healed. Safety was assessed throughout the study.


RESULTS
Famciclovir was well tolerated, with a safety profile similar to that of placebo. Famciclovir accelerated lesion healing and reduced the duration of viral shedding. Most importantly, famciclovir recipients had faster resolution of postherpetic neuralgia (approximately twofold faster) than placebo recipients; differences between the placebo group and both the 500-mg famciclovir group (hazard ratio, 1.7 [95% CI, 1.1 to 2.7]) and the 750-mg famciclovir group (hazard ratio, 1.9 [CI, 1.2 to 2.9]) were statistically significant (P = 0.02 and 0.01, respectively). The median duration of postherpetic neuralgia was reduced by approximately 2 months.


CONCLUSIONS
Oral famciclovir, 500 mg or 750 mg three times daily for 7 days, is an effective and well-tolerated therapy for herpes zoster that decreases the duration of the disease's most debilitating complication, postherpetic neuralgia.
Tyring
S
S
University of Texas Medical Branch, Galveston, USA.
Barbarash
R A
RA
Nahlik
J E
JE
Cunningham
A
A
Marley
J
J
Heng
M
M
Jones
T
T
Rea
T
T
Boon
R
R
Saltzman
R
R
D015075:2-Aminopurine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000208:Acute Disease; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077595:Famciclovir; D005260:Female; D006562:Herpes Zoster / Q000150:complications / Q000188:drug therapy*; D014645:Herpesvirus 3, Human / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D010349:Patient Compliance; D013997:Time Factors; D017201:Virus Shedding / Q000187:drug effects
D000998:Antiviral Agents; D015075:2-Aminopurine; D000077595:Famciclovir