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

Autores de IIS La Fe

• Vicente Ruiz García

  Autor

• María Ángeles Bort Martí

  Autor

Participantes ajenos a IIS La Fe

• Ruiz Sifre L
• Bort Martí S

Grupos

• Investigación en Neuroinmunología y Esclerosis Múltiple

• Unidad Mixta de Investigacion en TICs aplicadas a la reingeniería en procesos sociosanitarios (ERPSS)

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.

Copyright © 2025 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

Keywords

• Agentes antivirales; Agudeza visual; Antiviral agents; Keratitis herpetic; Prevención secundaria; Queratitis herpética; Recurrence; Recurrencia; Secondary prevention; Visual acuity