Combo therapy of oral valacyclovir with topical clobetasol best for managing herpes labialis

Several agents were effective in managing herpes labialis, "among these agents, the combination therapy of oral valacyclovir and topical clobetasol is the most effective in reducing the healing time," the researchers wrote in their study published in the Journal of Evidence-Based Dental Practice. They, however, add that there is a need for further studies is required to determine the most effective intervention for preventing its recurrence.

Herpes labialis is an infectious disease that results from HSV-1 (herpes simplex virus type 1) in the orofacial region and is particularly common in adolescents and infants. After the initial exposure, the primary infection spreads to sensory nerve cells and establishes latent infections. The chances of the recurrence of herpes labialis are common among people where the disease is contagious during active replication but can also spread when symptoms are absent.

Kim Hoe Koe, International Medical University, Kuala Lumpur, Malaysia, and colleagues aimed to compare the relative safety and efficacy of antiviral agents used to prevent and manage herpes labialis through a network meta-analysis of clinical trials.

For this purpose, the researchers systematically searched online databases for RCTs (randomized controlled trials) reporting a comparison of antiviral agents in managing and preventing herpes labialis in healthy/immunocompetent adults. The researchers assessed data extracted from the selected RCTs and performed a network meta-analysis. The interventions were ranked according to the SUCRA (surface under the cumulative ranking).

Fifty-two articles were included for qualitative synthesis, and in the quantitative part, seven studies were analyzed for the primary prevention outcome, and 26 papers were analyzed for the primary treatment outcome.

The study revealed the following findings:

• The combination therapy of oral valacyclovir and topical clobetasol was the best ranked, with a mean reduction in healing time of -3.50, followed by vidarabine monophosphate of -3.22.
• No significant inconsistencies, publication bias, or heterogeneity were reported for TTH outcome analysis.
• Only 7 RCTs fulfilled the inclusion criteria for primary prevention outcomes, and none of the interventions was shown to be superior to the other.
• Sixteen studies reported no adverse events, whereas others only reported mild side effects.

"Based on the available evidence, the combination therapy of topical clobetasol and oral valacyclovir ranked first in the reduction of the healing time metric, followed by vidarabine monophosphate," the researchers concluded.

Reference:

Koe, K. H., Veettil, S. K., Maharajan, M. K., Syeed, M. S., Nair, A. B., & Gopinath, D. (2023). COMPARATIVE EFFICACY OF ANTIVIRAL AGENTS FOR PREVENTION AND MANAGEMENT OF HERPES LABIALIS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. Journal of Evidence-Based Dental Practice, 23(1), 101778. https://doi.org/10.1016/j.jebdp.2022.101778