A RANDOMIZED CONTROLLED TRIAL OF ACYCLOVIR VERSUS NETIVUDINE FOR TREATMENT OF HERPES-ZOSTER

Oral acyclovir has become the standard of care for treatment of acute herpes zoster. Netivudine is a novel antiviral with greater in-vitro a ctivity against varicella zoster virus. It was compared with acyclovir in a randomized, double-blind, controlled trial in immunocompetent ad ults with herpes zoster. Patients with rash for less than 72 h were as signed to receive either acyclovir or netivudine, then assessed regula rly for 6 months. No evidence for a dose response with netivudine was found, so intent-to-treat analyses of all 511 enrolled patients compar ed acyclovir with netivudine. The time to complete cessation of pain ( P = 0.007) and to cessation of moderate to excruciating pain (P = 0.00 5) was accelerated in acyclovir recipients. Rash outcomes and adverse event profiles were similar for both treatments. This study has confir med the efficacy of acyclovir in decreasing the duration and severity of pain following herpes zoster. Greater in-vitro activity of newer ag ents may not necessarily provide greater benefit in humans.