WASHINGTON — A single-day treatment of famciclovir taken by a patient within 6 hours of a genital herpes outbreak can significantly speed the time to healing, Dr. Fred Y. Aoki reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
Current regimens for episodic genital herpes have become shorter and shorter without a loss of efficacy. That, along with pathogenesis data demonstrating that herpes simplex virus (HSV) titers increase in lesions only over the first 24 hours, provide the rationale for use of a single-day, two-dose regimen of 1,000 mg of famciclovir, said Dr. Aoki, professor of medicine, medical microbiology, pharmacology, and therapeutics at the University of Manitoba, Winnipeg.
In a Novartis-funded study, a total of 229 patients aged 18–82 years with at least 4 outbreaks of genital herpes in the preceding 12 months and laboratory-confirmed HSV-2 infection were instructed to take either 1,000 mg of famciclovir twice in one day or placebo, beginning within 6 hours of prodromal symptom onset or the appearance of lesions.
In the intention-to-treat analysis of 125 famciclovir and 145 placebo subjects, the proportion of patients with aborted lesions was 23% with famciclovir vs. 13% with placebo. This difference “was statistically significant and probably clinically important,” Dr. Aoki noted.
Time to healing was also significantly shorter with famciclovir (4 vs. 6 days), as was time to resolution of individual symptoms, with differences ranging from a 29% shorter time to resolution of tingling to a 41% quicker resolution of both itching and tenderness.
Among the two-thirds of patients who had all five classic herpes symptoms—burning, pain, tingling, itching, tenderness—time to resolution of all was approximately 2 days shorter with famciclovir, he said.
Total adverse events were reported by 26% of the famciclovir group and 24% with placebo. There were no reported serious adverse events, and none of the subjects discontinued due to adverse events. Two were reported significantly more often with famcyclovir: diarrhea (5% vs. 1%) and headache (14% vs. 5%). The headaches were mostly of mild to moderate severity and were resolved by analgesics, Dr. Aoki noted.
In response to a question from the audience, Dr. Aoki advised that physicians educate patients with recurrent genital herpes about the disease and its treatment, and then give them a prescription to fill before an outbreak occurs.
Educate patients about the disease and its treatment, and tell them to fill a prescription before an outbreak occurs. DR. AOKI