Department of Medicine, Division of Nephrology, Western University, London, ON N6A 3 K7, Canada.
BMC Pharmacol Toxicol. 2014 Sep 4;15:48. doi: 10.1186/2050-6511-15-48.
Higher versus lower doses of antiviral drugs used to treat herpes zoster infection may lead to more adverse drug events in older adults, particularly those with chronic kidney disease.
We conducted a matched retrospective population-based cohort study of older adults (mean 77 years) in Ontario, Canada who initiated in the outpatient setting a higher (n = 23,256) or lower (n = 3,876) dose of one of three oral antivirals for the treatment of herpes zoster between 2002 and 2011. The primary outcome was hospitalization within 30 days with evidence of a computed tomography (CT) scan of the head (a proxy for acute neurotoxicity). The secondary outcome was 30-day all-cause mortality.
A higher compared to lower dose of antiviral drug was not associated with an increased risk of hospitalization with an urgent CT scan of the head (247 [1.06%] events with higher dose versus 43 [1.11%] events with lower dose, relative risk 0.96, 95% confidence interval 0.69 to 1.33, p-value 0.79) and was not associated with a higher risk of all-cause mortality (63 [0.27%] events versus 15 [0.39%] events, relative risk 0.70, 95% confidence interval 0.40 to 1.23, p-value 0.21). Results were consistent in all subgroups, including those with and without chronic kidney disease.
Initiating a higher compared to a lower dose of an antiviral drug for the treatment of herpes zoster was not associated with an increased risk of adverse drug events. The findings support the safety of these drugs in older adults as currently prescribed in routine care.
用于治疗带状疱疹感染的抗病毒药物剂量较高与剂量较低相比，可能会导致老年患者（尤其是患有慢性肾脏病的患者）发生更多药物不良反应。
我们对加拿大安大略省的老年患者（平均年龄为 77 岁）进行了一项匹配的回顾性基于人群的队列研究，这些患者在 2002 年至 2011 年间，在门诊环境中开始使用三种口服抗病毒药物中的一种，剂量较高（n=23256）或较低（n=3876），以治疗带状疱疹。主要结局是在 30 天内因有证据提示行头颅 CT 扫描（急性神经毒性的替代指标）而住院。次要结局是 30 天全因死亡率。
与使用较低剂量抗病毒药物相比，使用较高剂量药物并未增加因紧急头颅 CT 扫描而住院的风险（较高剂量组发生 247 例[1.06%]事件，较低剂量组发生 43 例[1.11%]事件，相对风险 0.96，95%置信区间 0.69 至 1.33，p 值 0.79），也未增加全因死亡率的风险（较高剂量组发生 63 例[0.27%]事件，较低剂量组发生 15 例[0.39%]事件，相对风险 0.70，95%置信区间 0.40 至 1.23，p 值 0.21）。结果在所有亚组中均一致，包括有和无慢性肾脏病的患者。
与使用较低剂量抗病毒药物相比，起始使用较高剂量的抗病毒药物治疗带状疱疹并不会增加药物不良反应的风险。这些发现支持这些药物在常规治疗中目前的使用剂量下对老年患者的安全性。
