School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia.
Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, USA.
J Evid Based Dent Pract. 2023 Mar;23(1):101778. doi: 10.1016/j.jebdp.2022.101778. Epub 2022 Sep 14.
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.
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).
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.
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.
通过对临床试验的网络荟萃分析，比较用于预防和治疗唇疱疹的抗病毒药物的相对疗效和安全性。
在 Ovid Medline PubMed、Cochrane 中央对照试验注册中心（CENTRAL）、Scopus 和 Clinicaltrials.gov 中对随机对照试验（RCT）进行系统检索，这些 RCT 报告了比较健康/免疫功能正常成年人中用于管理和预防唇疱疹的抗病毒药物的疗效。从选定的 RCT 中提取数据并进行网络荟萃分析（NMA）。根据累积排序概率（SUCRA）对干预措施进行排名。
共有 52 篇文章进行定性综合分析，对于定量部分，26 篇文章分析了主要治疗结果，7 项研究分析了主要预防结果。口服伐昔洛韦联合局部卤倍他索的联合治疗是排名最高的，平均愈合时间缩短 -3.50（95%CI-5.22 至-1.78），其次是单磷酸阿昔洛韦-3.22（95%CI-4.59 至-1.85）。TTH 结果分析未报告明显的不一致性、异质性和发表偏倚。对于主要预防结果，只有 7 项 RCT 符合纳入标准，没有一种干预措施显示优于其他干预措施。16 项研究报告无不良反应，而其他研究仅报告轻微副作用。
NMA 强调，几种药物在治疗唇疱疹方面有效，其中口服伐昔洛韦联合局部卤倍他索治疗在缩短愈合时间方面最有效。然而，还需要进一步的研究来确定哪种干预措施在预防唇疱疹复发方面最有效。
