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Intervention Review

Antiviral treatment for preventing postherpetic neuralgia

  1. Qifu Li2,
  2. Ning Chen2,
  3. Jie Yang2,
  4. Muke Zhou2,
  5. Dong Zhou2,
  6. Quanwei Zhang3,
  7. Li He1,*

Editorial Group: Cochrane Neuromuscular Disease Group

Published Online: 15 APR 2009

Assessed as up-to-date: 12 JAN 2009

DOI: 10.1002/14651858.CD006866.pub2


How to Cite

Li Q, Chen N, Yang J, Zhou M, Zhou D, Zhang Q, He L. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006866. DOI: 10.1002/14651858.CD006866.pub2.

Author Information

  1. 1

    West China Hospital, Sichuan University, Department of Neurology, Chengdu , Sichuan, China

  2. 2

    West China Hospital, Sichuan University, Department of Neurology, Chengdu, China

  3. 3

    Michigan Physicians Group PC, Neurology, Troy, USA

*Li He, Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Xiang #37, Chengdu , Sichuan, 610041, China. heli2003new@126.com.

Publication History

  1. Publication Status: New
  2. Published Online: 15 APR 2009

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This is not the most recent version of the article. View current version (06 FEB 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Postherpetic neuralgia (PHN) is a painful and refractory complication of herpes zoster. Treatments are either partially or totally ineffective for many people with PHN. Antiviral agents, used at the time of the rash, are one of the best-established approaches that may prevent the development of PHN.

Objectives

To investigate the effectiveness of antiviral agents in preventing PHN.

Search methods

We searched the Cochrane Neuromuscular Disease Group Trials Register (January 13 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE (January 1966 to November Week 3 2008), EMBASE (January 1980 to Week 02 2009), LILACS (January 1982 to 13 January 2009), and the Chinese Biomedical Retrieval System (January 1978 to 13 January 2009). We checked the references of published studies to identify additional trials.

Selection criteria

All randomised and quasi-randomised controlled trials for antiviral treatment given within 72 hours after the onset of herpes zoster for preventing PHN irrespective of any language restrictions.

Data collection and analysis

Two authors independently selected trials and evaluated the methodological quality, then extracted and analysed data from the included trials.

Main results

Twenty trials were identified. Twelve trials were excluded and two trials are awaiting classification. Six randomised controlled trials, with a total of 1211 participants were eligible; five trials evaluated oral acyclovir, and one trial with 419 participants evaluated oral famciclovir. There was no significant difference between the oral acyclovir and control groups on the incidence of PHN four months (risk ratio (RR), 0.75; 95% CI 0.51 to 1.11; P = 0.15) or six months (RR 1.05, 95% CI 0.87 to 1.27; P = 0.62) after the onset of the acute herpetic rash. There was some evidence for a reduction in the incidence of pain four weeks after the onset of rash. In the trial of famciclovir versus placebo, neither 500 mg and 750 mg doses of famciclovir reduced the incidence of herpetic neuralgia significantly.

Authors' conclusions

Oral acyclovir did not reduce the incidence of PHN significantly. There is insufficient evidence from randomised controlled trials to determine whether other antiviral treatments prevent PHN. Additional well-designed, randomised controlled trials of famciclovir or other new antiviral agents, with a greater number of participants are needed. Future trials should pay more attention to the severity of pain and quality of life of participants, and should be conducted among different subgroups of people, such as people who are immunocompromised.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Antiviral treatment for preventing postherpetic neuralgia

Postherpetic neuralgia (PHN) is a painful condition occurring after herpes zoster (shingles) in which pain persists in the area where the rash emerged. Treatments for PHN are either partially, or totally, ineffective for many people with PHN. Attention has therefore turned to approaches that may prevent the development of PHN. Antiviral agents, used at the time of the rash, are the best-established preventative approach. To investigate the effectiveness of antiviral agents in preventing PHN from developing, we conducted a systematic review. We identified six trials involving 1211 participants, that were suitable for inclusion in the review. There was no significant difference between the antiviral (either oral acyclovir or oral famciclovir) and placebo control groups in the presence of PHN four or six months after the rash onset. Oral acyclovir was ineffective in reducing the incidence of PHN, while insufficient evidence was found to recommend other antiviral treatments to prevent PHN. Further well-designed, randomised, controlled trials of famciclovir or other new antiviral agents with a greater number of participants are needed. Future trials should pay more attention to the severity of pain and quality of life of participants, and should be conducted among different groups of people, such as people who are immunocompromised.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

抗病毒藥物對皰疹後神經痛的預防

皰疹後神經痛(PHN)是皰疹水痘病毒感染後的一種頑固性疼痛的併發症.對很多人來說,不是治療效果有限就是完全沒有作用.抗病毒藥物在皮膚剛出疹時就使用,已經被認定為最好的治療方式之ㄧ,或許可以用來預防皰疹後神經痛的產生.

目標

為了調查抗病毒藥物在預防皰疹後神經痛的效果

搜尋策略

我們收尋了考科藍神經肌肉疾病群體試驗紀錄(1月13日,2009年),考科藍中心控制組試驗紀錄(考科藍資料庫2008, Issue 4), MEDLINE(1月1996年到11月第三週 2008), EMBASE(1月1980年到第2周2009年), LILACS(1月1982年到1月13日,2009年),和the Chinese Biomedical Retrieval System(1月1978到1月13日,2009年).我們搜尋了已刊出研究的參考資料,為了找出更多的臨床試驗資料.

選擇標準

所有隨機和半隨機的對照組試驗,其中用來預防皰疹後神經痛的抗病毒藥物,都是在皰疹水痘病毒感染的72小時之內給予,並沒有包括任何語言的限制.

資料收集與分析

由兩個作者獨立的選擇試驗和評估方法學的品質,然後從選擇的試驗中擷取和分析資料.

主要結論

20個試驗被選取.12個試驗被排除,2個試驗正在等待被分類.6個隨機對照組試驗,包括1211個受試者是適合的;5個試驗評估口服的acyclovir,而1個有419個受試者的試驗評估口服的famiclovir.其中在口服acyclovir和對照組之間,在預防PHN的發生率上,並沒有統計學上的意義,不管是在長水泡後4個月(risk ratio (RR), 0.75; 95% CI 0.51 to 1.11; P = 0.15)或6個月(RR 1.05, 95% CI 0.87 to 1.27; P = 0.62).有一些證據顯示可以減少長水泡4周後的疼痛.在famciclovir和對照組比較的試驗,不論是500mg和750mg的famciclovir,都不能減少皰疹後神經痛的發生率.

作者結論

口服acyclovir不能減少PHN的發生率.從隨機的對照組試驗,並沒有足夠的證據顯示其他抗病毒藥物是否可以預防PHN.更多的設計良好的隨機試驗,針對famciclovir或其他新的抗病毒藥物的試驗,更多的受試者是需要的.未來的試驗應著重在疼痛的嚴重度和受試者的生活品質,而且應該在不同類型的人群上進行,例如免疫力差的人群.

翻譯人

本摘要由新光醫院李建欣翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

PNH是一種水痘病毒感染後的疼痛情形,它疼痛的部位是在有長水泡的地方(shingles). 對於PNH的治療對許多人來說,不是部份有效,就是完全沒有效果.因此注意力被放在可以預防PNH發生的治療方法上.抗病毒藥物在皮膚剛出疹時就使用,是其中一種已經被認定為最好的預防方式.為了調查抗病毒藥物對於預防PNH的效果,我們進行了系統性的回顧.我們找到了6個隨機對照組試驗,包括1211個受試者,是符合這個回顧的.其中在口服acyclovir或口服famciclovir和對照組比較,在預防4到6個月後PHN的發生率上,並沒有統計學上的意義.口服acyclovir不能減少PHN的發生率.而其他的抗病毒藥物也沒有足夠的證據顯示可以預防PNH.需要更多的設計良好的隨機試驗,針對famciclovir或其他新的抗病毒藥物,和需要更多的受試者.未來的試驗應著重在疼痛的嚴重度和受試者的生活品質,而且應該在不同類型的人群上進行,例如免疫力差的人群.