Highlights
- Shingles can lead to debilitating complications, emphasizing the need for effective treatment and prevention strategies.
- New antiviral therapies like valacyclovir and advanced vaccines like Shingrix enhance patient outcomes significantly.
- Engaging with preventive measures, such as vaccinations, can dramatically reduce the risk of shingles and its severe effects.
Summary and Overview of Shingles
Shingles, or herpes zoster, is a painful viral infection caused by reactivation of the varicella-zoster virus, which also causes chickenpox. It mainly affects older adults and immunocompromised individuals, presenting as a painful, blistering rash often on one side of the torso. Complications include postherpetic neuralgia (PHN), a chronic nerve pain affecting up to 30% of patients and severely impacting quality of life. Diagnosis is clinical, based on pain and rash presentation, and treatment involves antiviral medications and pain management. Recent studies also explore combining pharmacological therapies with alternatives like ozone autohemotherapy to reduce PHN pain.
Standard Treatments
There is no cure for shingles, but treatment focuses on symptom relief and complication prevention. Antiviral drugs such as acyclovir, valacyclovir, and famciclovir inhibit viral replication, shorten rash duration, and reduce complications, especially when started within 72 hours of rash onset. Valacyclovir and famciclovir offer improved bioavailability and less frequent dosing than acyclovir, enhancing adherence. Additional antivirals like brivudine and amenamevir are under study. Pain is managed with analgesics, corticosteroids, topical agents, and gabapentin for PHN. Despite guidelines, antivirals are sometimes under-prescribed, highlighting the need for improved clinical practice.
Recent Advances in Treatment
Antiviral therapies have improved with prodrugs enabling better dosing and compliance. Extended antiviral treatment, up to a year as shown in the Zoster Eye Disease Study (ZEDS), may prevent complications like herpes zoster ophthalmicus. Novel antivirals and drug delivery systems, such as chitosan-based nanoparticles, are being developed to enhance efficacy and reduce side effects. Immunotherapeutic approaches combining antivirals with agents stimulating innate immunity show promise, especially in elderly patients.
Vaccination remains the most effective prevention. The recombinant zoster vaccine (Shingrix) offers over 90% efficacy in adults aged 50+, including immunocompromised individuals. New mRNA vaccine candidates by Pfizer and BioNTech are in clinical trials aiming for improved immunogenicity and scalable production to increase global access.
Clinical Trials and Research
Ongoing studies include a Phase 1/2 trial of novel mRNA shingles vaccines enrolling adults aged 50-69. Observational research highlights the importance of completing the two-dose Shingrix regimen for sustained protection. The ZEDS study supports extended antiviral therapy to prevent eye complications and recurrent disease. Research into chitosan-based drug carriers aims to optimize antiviral delivery and reduce toxicity. These efforts focus on enhancing vaccines, antiviral therapies, and treatment delivery to improve outcomes.
Impact and Future Directions
Extended antiviral therapy with valacyclovir reduces herpes zoster ophthalmicus complications and flare-ups, improving patient outcomes. Antivirals remain central to managing shingles by limiting viral replication and pain, especially in older and immunocompromised patients. Emerging strategies include immunomodulatory adjuncts, such as combining antivirals with experimental vaccines to boost antiviral responses.
Future developments focus on mRNA vaccine technology from Pfizer and BioNTech and advanced antiviral delivery using chitosan polymers for targeted, controlled drug release. Topical antiviral treatments are also being explored as alternative or complementary therapies, aiming to enhance treatment accessibility and effectiveness.
The content is provided by Sierra Knightley, Scopewires
