COMPARATIVE EFFICACY OF ANTIVIRAL AGENTS FOR PREVENTION AND MANAGEMENT OF HERPES LABIALIS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Kim Hoe Koe; Sajesh K Veettil; Mari Kannan Maharajan; M Sakil Syeed; Athira Balakrishnan Nair; Divya Gopinath

doi:10.1016/j.jebdp.2022.101778

COMPARATIVE EFFICACY OF ANTIVIRAL AGENTS FOR PREVENTION AND MANAGEMENT OF HERPES LABIALIS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

J Evid Based Dent Pract. 2023 Mar;23(1):101778. doi: 10.1016/j.jebdp.2022.101778. Epub 2022 Sep 14.

Authors

Kim Hoe Koe¹, Sajesh K Veettil², Mari Kannan Maharajan³, M Sakil Syeed², Athira Balakrishnan Nair⁴, Divya Gopinath⁵

Affiliations

¹ School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia.
² Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, USA.
³ School of Pharmacy, University of Nottingham Malaysia, Semenyih, 43500, Malaysia.
⁴ Freelancer, Evidence Synthesis.
⁵ Basic Medical and Dental Sciences Dept, College of Dentistry, Ajman University, P O Box 346, UAE; Centre for Transdisciplinary research, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India. Electronic address: divyagopinath@imu.edu.my.

PMID: 36914303
DOI: 10.1016/j.jebdp.2022.101778

Abstract

Objective: To compare the relative efficacy and safety of antiviral agents used in the prevention and management of herpes labialis through a network meta-analysis of clinical trials.

Methods: A systematic search was performed in Ovid Medline PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus and Clinicaltrials.gov for randomized controlled trials (RCTs) reporting a comparison of antiviral agents in the management and prevention of herpes labialis in healthy/immunocompetent adults. The data extracted from the selected RCTs were assessed and a network meta-analysis (NMA) was performed. The interventions were ranked according to the surface under the cumulative ranking (SUCRA).

Results: A total of 52 articles were included for qualitative synthesis and for the quantitative part, 26 articles were analyzed for the primary treatment outcome and 7 studies were analyzed for the primary prevention outcome. The combination therapy of oral valacyclovir and topical clobetasol was the best ranked with a mean reduction in healing time of -3.50 (95% CI -5.22 to -1.78) followed by vidarabine monophosphate of -3.22 (95% CI -4.59 to -1.85). No significant inconsistencies, heterogeneity, and publication bias were reported for TTH outcome analysis. For primary prevention outcomes, only 7 RCTs fulfilled the inclusion criteria, and none of the interventions was shown to be superior to each other. The absence of adverse events was reported by 16 studies, whereas other studies reported mild side effects only.

Conclusion: NMA highlighted that several agents were effective in the management of herpes labialis among which the combination of oral valacyclovir with topical clobetasol therapy was the most effective in reducing the time to heal. However, further studies are required to determine which intervention is the most effective in preventing the recurrence of herpes labialis.

Keywords: Antiviral agents; Efficacy; Herpes labialis; Management; Network Meta-analysis; Prevention; Systematic review; Treatments.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Antiviral Agents* / adverse effects
Antiviral Agents* / therapeutic use
Clobetasol
Herpes Labialis* / chemically induced
Herpes Labialis* / drug therapy
Herpes Labialis* / prevention & control
Humans
Network Meta-Analysis
Valacyclovir

Substances

Antiviral Agents
Clobetasol
Valacyclovir