Valaciclovir effectively suppresses Epstein-Barr virus in COPD patients

A new study published in CHEST Journal suggests that for the safe and efficient suppression of Epstein-Barr virus (EBV) in chronic pulmonary obstructive disorder (COPD), valaciclovir may also lessen the inflammatory cell infiltration in the sputum.

Using quantitative polymerase chain reaction (qPCR) on sputum, Epstein-Barr virus is regularly detected at high levels in COPD, but airway immunohistochemistry research has revealed that EBV detection is prevalent in severe illness. In order to assess the safety, effectiveness, and clinical consequences of valaciclovir for EBV suppression in COPD, Dermot A. Linden and colleagues undertook this study.

The Mater Hospital Belfast in Northern Ireland hosted the Epstein-Barr Virus Suppression in COPD experiment, which was a randomized, double-blind, placebo-controlled study. Eligible patients were randomly (1:1) allocated to receive valaciclovir (1 g tid) or a matched placebo for 8 weeks if they had persistent moderate-to-severe COPD and sputum EBV (measured using qPCR). At week eight, sputum EBV suppression (defined as a drop in viral load of 90%) was the main efficacy result. The frequency of significant adverse events was the main safety consequence. FEV1 and medication tolerance were secondary outcome indicators. Changes in sputum cell counts, cytokine counts, and quality of life were among the exploratory results.

The key findings of this study were:

1. 84 individuals were randomly randomized between November 2, 2018, and March 12, 2020 (n = 43 to valaciclovir).

2. 81 patients who successfully completed the trial's follow-up were counted in the analysis of the primary outcome's intention-to-treat population.

3. More people in the valaciclovir group were successful in suppressing EBV.

4. When compared to a placebo, valaciclovir was linked to a significantly lower sputum EBV titer.

5. The valaciclovir group demonstrated a 24-mL numerical FEV1 rise that was statistically insignificant.

6. In contrast to the placebo group, the valaciclovir group had a lower sputum white cell count.

Reference: 

Linden, D. A., Guo-Parke, H., McKelvey, M. C., Einarsson, G. G., Lee, A. J., Fairley, D. J., Brown, V., Lundy, G., Campbell, C., Logan, D., McFarland, M., Singh, D., McAuley, D. F., Taggart, C. C., & Kidney, J. C. (2023). Valaciclovir for Epstein-Barr Virus Suppression in Moderate-to-Severe COPD. In Chest. Elsevier BV. https://doi.org/10.1016/j.chest.2023.03.040