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Valacyclovir failed to prevent HSV-2 meningitis recurrence
Researchers from the Karolinska University Hospital in Stockholm, Sweden, did not recommend valacyclovir 0.5 g twice daily for the treatment of recurrent meningitis in patients with herpes simplex virus type 2 meningitis.
After year 1, no significant differences were observed between the treatment (n=45) and placebo arms (n=38). During year 2, with no treatment, the risk for recurrent HSV-2 meningitis was higher among those exposed to valacyclovir (HR=3.29; 95% CI, 10.06-10.21).
For the double blind, randomized controlled trial, the researchers set out to determine whether valacyclovir twice daily for 1 year after initial treatment would prevent the recurrence of meningitis in those with HSV-2 meningitis. Patients were randomly assigned to placebo or valacyclovir 0.5 g twice daily for 1 year after initial treatment of valacyclovir 1 g three times daily for 1 week.
During the 2 years of observation, there were 48 meningitis episodes, with a cluster observed in the valacyclovir group after stopping treatment.
Discontinuation of treatment occurred in five patients assigned to the valacyclovir arm and in 13 patients assigned placebo. Reasons for discontinuation included: adverse effects, pregnancy, frequent recurrence of genital herpes and new episodes of acute meningitis.
“Our data do not provide support for antiviral suppression at the dosage tested following HSV-2 meningitis,” the researchers wrote. “However, it cannot be ruled out that tailored suppressive treatment may be of benefit to some patients with frequent recurrences. Further pathophysiological studies of the complex mechanisms of reactivation of HSV-2 in the central nervous system are desired, as well as studies on suppressive antiviral treatment to prohibit recurrent meningitis.”
References:
- Aurelius E. Clin Infect Dis. 2012;54:1304-1313.
Disclosures:
- The researchers report no financial disclosures.