Abstract
Background: Epstein-Barr virus (EBV) is frequently detected at high levels in stable COPD using sputum quantitative polymerase chain reaction (qPCR) whilst airway immunohistochemistry indicates EBV is more common in severe disease.
Objectives: To evaluate the safety and efficacy of valaciclovir for EBV suppression in COPD.
Methods: EViSCO was a randomised, double-blind, placebo-controlled trial. Eligible participants with moderate-to-severe COPD and sputum EBV detection using qPCR were randomised to valaciclovir 1000mg or matching placebo thrice daily for 8 weeks. The primary efficacy outcome was EBV suppression (defined as >90% sputum viral load reduction) at week 8. The primary safety outcome was the incidence of serious adverse reactions (SARs). Secondary outcomes were FEV1 and drug compliance. Exploratory outcomes included quality-of-life, sputum biomarkers and microbiota.
Results: In total, 84 patients were randomly assigned to valaciclovir or placebo with 81 included in the intention-to-treat analysis (41 valaciclovir). A greater number of participants in the valaciclovir group achieved EBV suppression (n=36 (87.8%) vs. n=17 (42.5%); P < 0.001). Valaciclovir was associated with a significant reduction in sputum EBV qPCR titre at week 8 (-90404 copies/ml [IQR -298000, -15200] vs. -3940 copies/ml [IQR -114400, 50150]; P=0.002). There were no SARs in either group. We found no between-group differences in FEV1 or quality-of-life. Sputum total cell count was reduced in the valaciclovir group (difference 2.89;[95% CI 1.5 x106-7.4 x 106]; P=0.003).
Conclusions: Valaciclovir is safe and effective for EBV suppression in COPD and may attenuate inflammation.
Objectives: To evaluate the safety and efficacy of valaciclovir for EBV suppression in COPD.
Methods: EViSCO was a randomised, double-blind, placebo-controlled trial. Eligible participants with moderate-to-severe COPD and sputum EBV detection using qPCR were randomised to valaciclovir 1000mg or matching placebo thrice daily for 8 weeks. The primary efficacy outcome was EBV suppression (defined as >90% sputum viral load reduction) at week 8. The primary safety outcome was the incidence of serious adverse reactions (SARs). Secondary outcomes were FEV1 and drug compliance. Exploratory outcomes included quality-of-life, sputum biomarkers and microbiota.
Results: In total, 84 patients were randomly assigned to valaciclovir or placebo with 81 included in the intention-to-treat analysis (41 valaciclovir). A greater number of participants in the valaciclovir group achieved EBV suppression (n=36 (87.8%) vs. n=17 (42.5%); P < 0.001). Valaciclovir was associated with a significant reduction in sputum EBV qPCR titre at week 8 (-90404 copies/ml [IQR -298000, -15200] vs. -3940 copies/ml [IQR -114400, 50150]; P=0.002). There were no SARs in either group. We found no between-group differences in FEV1 or quality-of-life. Sputum total cell count was reduced in the valaciclovir group (difference 2.89;[95% CI 1.5 x106-7.4 x 106]; P=0.003).
Conclusions: Valaciclovir is safe and effective for EBV suppression in COPD and may attenuate inflammation.
| Original language | English |
|---|---|
| Article number | 856 |
| Journal | European Respiratory Journal |
| Volume | 60 |
| Issue number | Suppl 66 |
| DOIs | |
| Publication status | Published - 04 Sept 2022 |
| Event | European Respiratory Society International Congress 2022 - Barcelona, Spain Duration: 14 Nov 2022 → 18 Nov 2022 https://www.ers-education.org/events/international-congress/barcelona-2022/ |