The Effect of Treating Herpes Zoster With Oral Acyclovir in Preventing Postherpetic Neuralgia: A Meta-analysis

doi:10.1001/archinte.1997.00440290095010

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Vol. 157 No. 8, 28 APRIL 1997

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The Effect of Treating Herpes Zoster With Oral Acyclovir in Preventing Postherpetic Neuralgia

A Meta-analysis

Jeffrey L. Jackson, MD, MPH; Robert Gibbons, MD; Gregg Meyer, MD, MSc; Lisa Inouye, MD, MPH

Arch Intern Med. 1997;157(8):909-912.

Abstract

Background
Herpes zoster is a common affliction in older patients, withup to 15% experiencing some residual pain in the distributionof the rash several months after healing. Despite numerous randomizedclinical trials, the effect of treating herpes zoster with oralacyclovir in preventing postherpetic neuralgia remains uncertainbecause of conflicting results.

Methods
Meta-analysis of published randomized clinical trials on theuse of acyclovir to prevent postherpetic neuralgia using thefixed-effects model of Peto.

Results
Thirty clinical trials of treatment with oral acyclovir in immunocompetentadults were identified. After excluding studies with duplicatedata, suboptimal and topical dosing, non—placebo-controlledor nonrandomized designs, and those using intravenous acyclovir,5 trials were found to be homogeneous and were combined foranalysis. From these trials, the summary odds ratio for theincidence of "any pain" in the distribution of rash at 6 monthsin adults treated with acyclovir was 0.54 (95% confidence interval,0.36-0.81).

Conclusion
Treatment of herpes zoster with 800 mg/d of oral acyclovir within72 hours of rash onset may reduce the incidence of residualpain at 6 months by 46% in immunocompetent adults.

Arch Intern Med. 1997;157:909-912

Author Affiliations

From the Department of Medicine, Madigan Army Medical Center, Tacoma, Wash (Dr Jackson); the Department of Medicine, Walter Reed Army Medical Center, Washington, DC (Dr Gibbons); the Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Meyer); and the Department of Medicine, Portsmouth Naval Medical Center, Portsmouth, Va (Dr Inouye).

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