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Spotswood L. Spruance, MD; Stephen K. Tyring, MD; Barry DeGregorio, MD; Cheryl Miller, PharmD; Karl Beutner, MD

Arch Intern Med. 1996;156(15):1729-1735.

Abstract
Background
Valaciclovir, the 1-valyl ester of acyclovir, has provided a peroral acyclovir bioavailability 3 to 5 times that of acyclovir itself and is rapidly and completely converted to acyclovir by the liver. Accordingly, valaciclovir has the same antiviral activity as acyclovir, but the potential for enhanced clinical activity and/or less frequent administration because of its superior pharmacokinetics.

Methods
We conducted a double-blind, placebo-controlled, patient-initiated clinical trial of peroral valaciclovir, 500 or 1000 mg, or matching placebo tablets twice daily for 5 days for the acute treatment of 1 episode of recurrent herpes genitalis among 987 otherwise healthy volunteers.

Results
Both doses of valaciclovir were equally effective. Patients receiving the lower dose of valaciclovir experienced a median episode length of 4.0 days compared with 5.9 days for those receiving placebo treatment (hazard ratio, 1.9; 95% confidence interval [CI], 1.6-2.3). Valaciclovir therapy increased the proportion of patients in whom the development of vesicular and ulcer-ative lesions was prevented in comparison with placebo treatment: 31% vs 21% (relative risk, 1.5; 95% CI, 1.1-1.9). Valaciclovir therapy accelerated the resolution of pain (hazard ratio, 1.8; 95% CI, 1.5-2.1) and the time to cessation of viral shedding (hazard ratio, 2.9; 95% CI, 2.1-3.9). Adverse reactions among the valaciclovir groups were comparable with those of the placebo group.

Conclusions
Valaciclovir therapy provided a clinically significant benefit to patients that included shortening of the duration of lesions, the duration of pain or discomfort, and the duration of virus shedding. In addition, this study, to our knowledge, provides the first convincing demonstration that antiviral therapy can prevent lesion development. These results should prompt a reconsideration of the role that episodic treatment plays in the management of recurrent herpes genitalis.

Arch Intern Med. 1996;156:1729-1735

Author Affiliations
the Valaciclovir HSV Study Group

From the Salt Lake City County Health Department and the University of Utah, Salt Lake City (Dr Spruance); University of Texas Medical Branch, Galveston (Dr Tyring); Oregon Health Sciences University, Portland (Dr DeGregorio); Deaconess Family Medicine Research Center, St Louis, Mo (Dr Miller); and the University of California at San Francisco (Dr Beutner).

Footnotes
A complete list of the members of the Valaciclovir HSV Study Group appears on page 1734.

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