Acyclovir Halts Progression of Herpes Zoster in Immunocompromised Patients

• Published in: The New England journal of medicine Vol. 308; no. 24; pp. 1448 - 1453
• Main Authors: Balfour, Henry H, Bean, Bonnie, Laskin, Oscar L, Ambinder, Richard F, Meyers, Joel D, Wade, James C, Zaia, John A, Aeppli, Dorothee, Kirk, L. Edward, Segreti, Anthony C, Keeney, Ronald E
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 16.06.1983
• Subjects: Acyclovir; Acyclovir - adverse effects; Acyclovir - therapeutic use; Adolescent; Adult; Aged; Antineoplastic agents; Biological and medical sciences; Cancer; Chemotherapy; Chicken pox; Child; Child, Preschool; Clinical Trials as Topic; Collaboration; Double-Blind Method; Exanthema; Family medical history; Female; Health sciences; Herpes zoster; Herpes Zoster - complications; Herpes Zoster - drug therapy; Humans; Immunocompromised hosts; Immunologic Deficiency Syndromes - complications; Infections; Intravenous administration; Laboratories; Leukemia - complications; Lymphoma - complications; Male; Medical research; Medical sciences; Middle Aged; Neoplasms - complications; Pain; Patients; Pharmacology. Drug treatments; Skin; Skin diseases; Transplantation, Homologous; varicella-zoster virus; Human; Infection; Chemotherapy; Immunosuppression; Skin disease; Zona; Viral disease; Double blind study; Herpes; Antiviral
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198306163082404

We conducted a placebo-controlled, double-blind study of acyclovir therapy for acute herpes zoster in immunocompromised patients. Of the 94 patients enrolled in the study, 52 had localized skin lesions at entry, and 42 had disseminated cutaneous zoster. A one-week course of intravenous acyclovir (1500 mg per square meter of body-surface area per day) halted progression of zoster in both groups, as determined by development or progression of cutaneous dissemination, development of visceral zoster, or proportion of cases deemed treatment failures. Significantly fewer patients treated with acyclovir within the first three days after the onset of exanthem had complications of zoster, as compared with patients treated with placebo (P = 0.02 by Fisher's exact test), but acyclovir also stopped progression of zoster in patients treated after three days of rash (P = 0.05 by Fisher's exact test). Acyclovir recipients with disseminated cutaneous zoster had a significantly accelerated rate of clearance of virus from vesicles, as compared with placebo recipients (P = 0.05 by the Breslow test). (N Engl J Med 1983; 308:1448–53.) A cute herpes zoster is a common cause of morbidity in immunocompromised patients, especially in those with lymphoproliferative neoplasia or organ allografts. 1 2 3 4 5 Because zoster may result in chronic pain and the danger of visceral dissemination is always present in immunocompromised hosts, immunocompromised patients with zoster are in need of an effective treatment. Both human leukocyte interferon 6 and vidarabine 7 , 8 have been shown to accelerate cutaneous healing and reduce visceral complications in immunocompromised patients with early localized zoster. Recently, placebo-controlled studies have provided documentation that intravenous acyclovir significantly shortens the time required for cutaneous healing, lessens pain, and decreases the period of . . .