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New Genital Herpes Treatment Safe, Effective

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A study finds a new class of anti-viral drug is safe and effective for treating outbreaks related to recurrent genital herpes.

Treatment for genital herpes currently involves taking drugs known as nucleoside analogues (such as valacyclovir) that work by inserting themselves into the viral DNA and disrupting the chain of viral replication.

Another class of drugs (not currently on the U.S. market) called helicase-primer inhibitors (HPI) also work by stopping HSV replication, but break up the chain in a different way. HPI target an enzyme called helicase-primase that facilitates HSV replication untwisting the DNA double helix of the virus. By acting on the enzyme, HPI keep the DNA strands intact. How well does it actually work?

To assess how well a novel HPI, ASP2151, works in healing lesions related to recurrent genital HSV, researchers randomized 427 subjects to receive either placebo or one of five treatment regimens: 100, 200, or 400 mg of ASP2151 daily for three days; a single 1200 mg dose of ASP2151, or 500 mg of valacyclovir twice daily for three days. Effectiveness was assessed by the amount of time (measured in hours) lesions took to heal (excluding aborted lesions).

Median healing time for lesions with the valacyclovir group was 114 hours. Healing time with the ASP regimens was similar: 102.1 hours with the 1200 mg group; 106.2 with 200 mg; and 115.9 with 400 mg. Median healing time for those receiving placebo was 139.8 hours.

In addition to showing promise in speeding healing time, the investigators say ASP2151 appears to be a safe option for treating recurrent genital HSV. However, at this time the company s not pursuing further development of this compound.

Reference
Tyring S, Wald A, Zadeikis N, Dhadda S, Takenouchi K, Rorig R. ASP2151 for the treatment of genital herpes: a randomized, double-blind, placebo- and valacyclovir-controlled, dose-finding study. J Infect Dis, 2012. 205(7):1100-10.

 

Evaluation of Patient Preferences for Genital Herpes Treatment

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A survey of patients with genital herpes indicates they want treatment, but cost factors into their decision making.

Medical treatment for genital herpes typically consists of oral antiviral medications that are either taken episodically (at the beginning of an outbreak) or as a daily, suppressive therapy regimen where intended to reduce or eliminate outbreaks altogether. Suppressive therapy is especially helpful in those who have frequent or severe outbreaks. Also, research with couples discordant for HSV-2 (where only one partner has the virus) has shown that suppressive therapy reduces transmission to uninfected partners. Genital herpes symptoms are often mild (and often unrecognized) and outbreaks tend to decrease in both severity and frequency over time, so treatment isn’t always indicated in each case.

In this study published in Sexually Transmitted Diseases, 154 subjects with genital herpes (and residing in the United States or United Kingdom) completed questionnaires that asked their preferences of three treatment regimens- episodic therapy, suppressive therapy plus episodic therapy (extra pills following an outbreak), and no treatment – that were presented in the context of “attributes” such as medical outcomes (including the chance of recurrences and transmission to a partner), convenience, and cost associated with each option.

Regardless of whether they were currently on episodic therapy, suppressive therapy, or receiving no treatment at all, patients in each group indicated a preference to receive some type of genital herpes antiviral treatment. Those receiving episodic therapy were largely indifferent regarding their current treatment regimen versus suppressive therapy; however, those receiving suppressive therapy strongly indicated a desire to remain on their daily regimen. Those receiving no treatment were more likely to be in favor of episodic therapy.

For many, cost impacted their decision on a treatment regimen: fewer than half of all subjects indicated they would choose suppressive therapy if their out-of-pocket would run $90 per month, but a majority in each treatment group indicated they would prefer suppressive therapy were it freely available.

Reference
Scalone L, Watson V, Ryan M, Kotsopoulos N, and Patel R. Evaluation of patients’ preferences for genital herpes treatment. Sex Trans Dis 2011. 38(9):802-807.

 



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