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A prognostic score for postherpetic neuralgia in ambulatory patients

  • Clinical and Epidemiological Studies
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Summary

The main objective was to develop a scoring system for easy use by the physician in daily clinical practice in deciding the appropriate treatment for his herpes zoster patient. Data from 635 patients who did not receive antiviral therapy were included in this analysis. Of these, 131 developed postherpetic neuralgia (PHN). Of the 29 variables tested univariately in this study, 15 showed a significant correlation with the incidence of PHN, but only six proved to contribute to the overall predictive power in the multivariate approach. Using two independent approaches, the model showed a very satisfactory performance in the validation sample. Patients without acute pain rarely developed PHN. In those with acute pain, being female, being over 50 years of age, having more than 50 lesions, having lesions of a hemorrhagic nature, having cranial or sacral localisation of the rash or having pain in the prodromal phase proved to be significant, multivariate factors. An easy-to-use scoring system used in a risk graph is proposed. These data should be useful in the individual treatment decision as well as in the design and analysis of therapeutic trials in herpes zoster.

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References

  1. Straus, S. E.: Varicella-zoster virus infections. Biology, natural history, treatment and prevention. Ann. Int. Med. 108 (1988) 221–237.

    CAS  PubMed  Google Scholar 

  2. Gilden, D.H.: Herpes zoster with postherpetic neuralgia_— persisting pain and frustration. N. Engl. J. Med. 13 (1994) 932–934.

    Article  Google Scholar 

  3. Portenoy, R. K., Duma, C., Foley, K. M.: Acute herpetic and postherpetic neuralgia: clinical review and current management. Ann. Neurol. 6 (1986) 651–664.

    Article  Google Scholar 

  4. Davies, L., Cossins, L., Bowsher, D., Drummond, M.: The cost of treatment for post-herpetic neuralgia in the UK. Pharmacoecon 6 (1994) 142–148.

    Article  CAS  Google Scholar 

  5. Kost, R. G., Straus, S. E.: Postherpetic neuralgia_— pathogenesis, treatment, and prevention: review article. N. Engl. J. Med. 335 (1994) 33–42.

    Google Scholar 

  6. Meister, W., Neiß, A., Gross, G., Dörr, W., Höbel, W. Malin, J.-P., von Essen, J., Reimann, B.-Y., Witke, C., Wutzler, P.: Epidemiology of zoster in ambulatory patients. Intervirology (in press).

  7. Harrel, F. E., Lee, K. L., Matchar, D. B., Reichert, T. A.: Regression models for prognostic prediction: advantages, problems and suggested solutions. Canc. Treat. Rep. 69 (1985) 1071–1077.

    Google Scholar 

  8. Hanley, J. A., McNeil, B. J.: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143 (1982) 29–36.

    CAS  PubMed  Google Scholar 

  9. Metz, C. E.: Basic principles of ROC analysis. Sem. Nucl. Med. 8 (1978) 283–398.

    Article  CAS  Google Scholar 

  10. Bowsher, D.: Post-herpetic neuralgia in older patients; incidence and optimal treatment. Drugs Aging 5 (1994) 411–418.

    Article  CAS  PubMed  Google Scholar 

  11. Hope-Simpson, R. E.: Postherpetic neuralgia. J. R. Coll. Gen. Pract. 25 (1975) 571–575.

    CAS  PubMed  Google Scholar 

  12. Dworkin, R., Boon, R., Griffin, D.: Covariates in herpes zoster and interpretation of clinical trial data. Antiviral Res. 26 (1995) A344.

    Google Scholar 

  13. Tyring, S., Rick, A., Nahlik, J. E., Cunningham, A., Marlex, J., Heng, M., Jones, T., Rea, T., Boon, R., Saltzman, R. andthe Collaborative Ficiclovir Herpes Zoster Study Group: Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. Ann. Int. Med. 123 (1995) 89–96.

    CAS  PubMed  Google Scholar 

  14. Beutner, K. R., Friedman, D. J., Forszpaniak, C., Andersen, P. L., Wood, M.: Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob. Agents Chemother. 37 (1995) 1546–1553.

    Google Scholar 

  15. Choo, W.: Risk factors for postherpetic neuralgia. Arch. Intern. Med. 157 (1997) 1217–1224.

    Article  CAS  PubMed  Google Scholar 

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Meister, W., Neiß, A., Gross, G. et al. A prognostic score for postherpetic neuralgia in ambulatory patients. Infection 26, 359–363 (1998). https://doi.org/10.1007/BF02770836

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  • DOI: https://doi.org/10.1007/BF02770836

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