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Valaciclovir and famciclovir ‘best for shingles’

Valaciclovir and famciclovir are the most effective antivirals for reducing pain in shingles and should be used first-line, say researchers.

Aciclovir is currently the most widely prescribed antiviral for shingles in the UK and is much cheaper, but the researchers concluded the clinical benefits made valaciclovir and famciclovir the ‘preferred treatment option’.

The researchers from New Zealand carried out a systematic review and meta-analysis of 12 randomised controlled trials involving 7,277 patients in which one antiviral was compared to another for a minimum of seven days in immunocompetent patients presenting with herpes zoster diagnosed within 72 hours of symptom onset.

Compared with aciclovir, valaciclovir showed significant reduction in herpes-zoster-associated pain up to 112 days with the largest risk reduction – at 36% - seen between 21 and 30 days. The number needed to treat to benefit (NNT) was three.

Famciclovir was also superior to aciclovir with a 46% reduction in risk of pain at 28 to 30 days and also had an NNT to benefit of three.

Time to lesion healing and adverse effect profile was comparable between all antivirals studied.

The authors concluded: ‘Valaciclovir or famciclovir should be preferred treatment options in patients with herpes zoster as they both provide significant reduction in risk of herpes-zoster-associated pain.

‘Furthermore, the superior pharmacokinetics and more convenient dosing regimens with the use of valaciclovir and famciclovir clearly make them the preferred treatment option.’

In the UK, acyclovir costs £9.13 for a course, compared with £86 for valaciclovir and £142 for famciclovir.

Antiviral Therapy 2012; 17:255-264

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