[Translated article] The need for prolonged antiviral use to prevent recurrences of herpes simplex virus ocular disease: A systematic review

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

FARMACIA HOSPITALARIA Pub Date : 2025-07-01 DOI:10.1016/j.farma.2025.03.019

Laura Ruiz Sifre , Sylvia Bort Martí , Vicente Ruiz García , Ángeles Ruth Bort Martí

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引用次数: 0

Abstract

Objective

To evaluate in patients with a history of keratitis by herpes simplex virus, ocular recurrences, visual acuity, non-ocular recurrences, stromal keratitis and adverse effects after prolonged treatment with antiviral agents. Registered in Prospero CRD42024556228.

Methods

Systematic review of trials identified in CENTRAL, Embase, Medline, www.ClinicalTrials.gov and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp). Trials of patients with a history of at least one episode of herpes simplex keratitis were included. Participants had to be free of active herpetic disease at the time of enrollment in the trial. Trials had to include oral and/or topical antiviral agents versus placebo or other antivirals, administered for at least 4 weeks. A data extraction was performed by pairs with risk of bias assessment for each trial using Cochrane Risk of Bias; GRADE was used to provide the certainty of evidence for each outcome.

Results

Four trials were found that included 1,017 patients. Antivirals in prolonged use protected from recurrences of ocular herpetic disease better than placebo (RR 0.56; 95% CI 0.45–0.70) NNT 6 (4–11); acyclovir was better than placebo in this same action (RR 0.59; 95% CI 0.46–0.74) NNT 8 (5–14), but not different from valacyclovir (RR 1.0; 95% CI 0.37–2.70) NNT not calculated. Prolonged use of antivirals also decreased recurrences of non-ocular herpetic disease (RR 0.56; 95% CI 0.44–0.71) NNT 6 (5–11) and recurrences with stromal keratitis (RR 0.55; 95% CI 0.35–0.85) NNT 17 (10–50). No data were found on visual acuity. Regarding adverse effects, there were no differences between interventions (RR 0.96; 95% CI 0.60–1.54) NNT not calculated. The certainty of evidence was high for ocular and non-ocular recurrences, and low for adverse effects, due to imprecision and inconsistency of the findings.

Conclusions

Prolonged use of antivirals protects from ocular, non-ocular recurrences and stromal keratitis safely. The effects on visual acuity are not known.

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长期使用抗病毒药物以预防单纯疱疹病毒眼病复发的必要性：一项系统综述。

目的：评价单纯疱疹病毒感染的角膜炎患者长期应用抗病毒药物治疗后眼部复发、视力、非眼部复发、间质角膜炎及不良反应。注册在普洛斯彼罗CRD42024556228。方法：对CENTRAL、Embase、Medline、www.Clinicaltrials: gov和世界卫生组织（WHO）国际临床试验注册平台（ICTRP）（www.who.int/ictrp）中确定的试验进行系统评价。至少有一次单纯疱疹性角膜炎发作史的患者纳入试验。参与者在入组试验时必须没有活动性疱疹疾病。试验必须包括口服和/或局部抗病毒药物与安慰剂或其他抗病毒药物，给药至少4 周。采用Cochrane偏倚风险评估对每项试验进行配对数据提取和偏倚风险评估；GRADE用于为每个结果提供证据的确定性。结果：4项试验纳入1017例患者。长期使用抗病毒药物对眼部疱疹复发的保护作用优于安慰剂(RR 0.56；95% ci 0.45-0.70) NNT 6 (4-11)；在相同的作用下，阿昔洛韦优于安慰剂(RR 0.59；95% CI 0.46-0.74) NNT 8(5-14)，但与valacyclovir无差异(RR 1.0；95% CI 0.37-2.70) NNT未计算。长期使用抗病毒药物也可降低非眼部疱疹性疾病的复发率(RR 0.56；95% CI 0.44-0.71) NNT 6（5-11）和复发间质角膜炎(RR 0.55；95% ci 0.35-0.85) NNT 17（10-50）。没有发现视力方面的数据。在不良反应方面，干预措施之间没有差异(RR 0.96；95% CI 0.60-1.54) NNT未计算。由于研究结果的不精确和不一致，眼部和非眼部复发的证据确定性较高，而不良反应的证据确定性较低。结论：长期使用抗病毒药物可安全预防眼部、非眼部复发和间质角膜炎。对视力的影响尚不清楚。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

FARMACIA HOSPITALARIA PHARMACOLOGY & PHARMACY-

CiteScore

1.90

自引率

21.40%

发文量

审稿时长

37 days

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