One year of valacyclovir beneficial for keratitis, iritis in herpes zoster ophthalmicus
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CHICAGO — Valacyclovir can be beneficial for treating multiple episodes of keratitis or iritis in patients with herpes zoster ophthalmicus, according to a speaker here.
Elisabeth Cohen, MD, presented results from the Zoster Eye Disease Study (ZEDS) during Cornea Subspecialty Day at the American Academy of Ophthalmology meeting. ZEDS was a double-masked, multicenter randomized controlled trial with the primary objective of determining if valacyclovir 1,000 mg daily is beneficial at 12 months for delaying time to occurrence of herpes zoster ophthalmicus manifestations including dendriform epithelial, stromal and endothelial keratitis, iritis, and stromal keratitis with ulceration. The secondary objective was the treatment benefit at 18 months.
Image: Eamon Dreisbach | Healio
The study’s secondary aim was to determine if valacyclovir can curb the severity, duration and incidence of postherpetic neuralgia in patients with herpes zoster ophthalmicus.
“Stromal keratitis was the most the most common endpoint, followed by iritis and dendriform epithelial keratitis,” Cohen said.
Five hundred twenty-seven patients were randomly assigned to receive either 1,000 mg of valacyclovir daily or placebo for 12 months, with follow-up every 3 months for 18 months; 460 patients completed the study at 18 months.
Although no significant benefit was observed at 12 months in patients who received valacyclovir, a significant benefit was seen at the 18-month follow-up. Patients also showed a significant decrease in the prevalence of postherpetic neuralgia at the 18-month mark.
“Importantly, there was a statistically significant reduction in the dose of neuropathic pain medicine at both 12 and 18 months among participants on valacyclovir,” she said. “The evidence supports recommending 1 year of suppressive valacyclovir to reduce pain in some and decrease pain duration overall at 18 months. One can speculate why benefit is greater at 18 months than 12 months, but perhaps it takes time for nerves to heal.”
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Cohen E, et al. Update on the Zoster Eye Disease Study (ZEDS). Presented at: American Academy of Ophthalmology meeting; Oct. 18-21, 2024; Chicago.
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