1977- Vira-A Efficacy for HSE
Vira-A Efficacy for HSE
Whitley RJ. Soong SJ. Dolin R. Galasso GJ. Ch'ien LT. Alford CA.
New England Journal of Medicine. 297(6):289-94, 1977 August 11
We evaluated adenine arabinoside (vidarabine) for treatment of herpes simplex encephalitis in a placebo-controlled study. In 28 cases proved by isolation of Type 1 virus from brain biopsy, treatment reduced mortality from 70 to 28 per cent (P = 0.03), and over 50 per cent of treated survivors had no or only moderately debilitating neurologic sequelae. This improvement was achieved without evidence of acute drug toxicity. Thus, adenine arabinoside has a good therapeutic index (efficacy/toxicity) for the treatment of Type 1 herpes simplex encephalitis. However, the drug must be given early in the course of infection before the advent of coma to have a beneficial effect. Moreover, it should be coupled with brain biopsy for specific diagnosis to avoid unnecessary treatment of nonresponsive encephalitides that can mimic herpes simplex.
1976 - Vira-A Efficacy for Zoster
Vira-A Efficacy for Zoster
Whitley RJ. Ch'ien LT. Dolin R. Galasso GJ. Alford CA Jr.
New England Journal of Medicine. 294(22):1193-9, 1976 May 27
We evaluated adenine arabinoside treatment of herpes zoster in immunodeficient patients in a randomized, controlled crossover study. The two study groups had similar characteristics. In spite of rapid natural healing, those receiving adenine arabinoside over the first five days had accelerated clearance of virus from vesicles (P = 0.01), and cessation of new vesicle formation (P = 0.004), and a shorter time to total pustulation (P = 0.001). Factors modifying the response to therapy included age, underlying disease, and the duration of zoster prior to therapy. Clinical toxicity was minimal. Laboratory assessment of bone marrow, liver and renal function showed insignificant alterations as a result of therapy. These studies show that adenine arabinoside is a drug with promise for therapy of systemic herpes zoster in immunocompromised patients. It is most efficacious when administered during the first six days of disease (P = 0.001) to those who have reticuloendothelial neoplasia (P = 0.001) and are less than 38 years of age (P = 0.001).
1975 - IDU Toxicity in HSE
IDU Toxicity in HSE
New England Journal of Medicine. 292(12):599-603, 1975 Mar 20
Two placebo-controlled double-blind studies were initiated to evaluate the therapeutic efficacy of 5-iodo-2-deoxyuridine (idoxuridine) in biopsy-proved cases of herpes simplex virus encephalitis. Twelve patients who on clinical grounds were thought to have herpes simplex virus encephalitis underwent brain biopsy; six of these patients were proved to have this disease, three were considered probable cases, and three were considered doubtful. The patients with proved or probably herpes simplex virus encephalitis were treated with parenteral idoxuridine (or placebo) at a dose of 100 mg per kilogram per day for five days. The occurrence of unacceptable myelosuppression and the failure of idoxuridine therapy to prevent death led to the premature termination of both studies.