Novel composite efficacy measure to demonstrate the rationale and efficacy of combination antiviral-anti-inflammatory treatment for recurrent herpes simplex labialis

Abstract

Historically, the primary target for research and treatment of recurrent herpes simplex labialis (HSL) has been limited to inhibiting herpes simplex virus (HSV) replication. Antiviral monotherapy, however, has proven only marginally effective in curtailing the duration and severity of recurrent lesions. Recently, the role of inflammation in the progression and resolution of recurrences has been identified as an additional target. This was evaluated in a randomized study comparing combination topical 5% acyclovir-1% hydrocortisone cream (AHC) with 5% acyclovir alone (AC; in the AHC vehicle) and the vehicle. The efficacy of each topical therapy was evaluated for cumulative lesion size--a novel composite efficacy endpoint incorporating episode duration, lesion area, and proportion of nonulcerative lesions. In that study, cumulative lesion area was significantly decreased with AHC compared with AC (25% decrease; P<0.05) and the vehicle (50% decrease; P<0.0001). As research continues in this arena, cumulative lesion area should be included as a measure of efficacy in clinical trials of recurrent HSL therapies.

FIG 1

Ulcerative recurrent herpes simplex labialis lesions. Conceptualization of relative contributions of viral and inflammatory processes over time. Episode stages and durations were based on information contained in reference .

FIG 2

Recurrent herpes simplex labialis lesions. Viral and inflammatory processes and antiviral and corticosteroid targets. COX2, cyclooxygenase 2; HSV, herpes simplex virus; IFN, interferon; IL, interleukin; iNOS, inducible nitric oxide synthase; LC1, lipocortin 1; MHC, major histocompatibility complex; NF, nuclear factor; NO, nitric oxide; PGs, prostaglandins; red , inhibited by corticosteroids; blue , inhibited by antivirals.