Valaciclovir suppresses Epstein-Barr virus in COPD patients

Treatment with valaciclovir leads to efficacious suppression of Epstein-Barr virus (EBV), having the potential to reduce the sputum inflammatory cell infiltrate, in patients with chronic obstructive pulmonary disease (COPD), according to data from the EViSCO study.

EViSCO included patients with stable moderate-to-severe COPD and sputum EBV (measured using qPCR). They were randomly assigned to receive either valaciclovir (1 g thrice daily) or matching placebo for 8 weeks.

The primary efficacy outcome was sputum EBV suppression (ie, >90-percent sputum viral load reduction) at week 8, while the secondary outcome measures were FEV1 and drug tolerability. The primary safety outcome was the occurrence of serious adverse reactions (SARs). Changes in quality of life, sputum cell counts, and cytokines were also assessed as exploratory outcomes.

A total of 84 patients were enrolled, of which 43 received valaciclovir and 41 received placebo. Of these, 81 patients completed trial follow-up and were included in the intention-to-treat analysis of primary outcome.

Results showed that twice as many patients in the valaciclovir group than in the placebo group achieved EBV suppression (87.8 percent vs 42.5 percent; p<0.001). Valaciclovir treatment led to a significant reduction in sputum EBV titre compared with placebo (–90,404 vs –3,940 copies/mL; p=0.002).

There was a numerical FEV1 increase observed in the valaciclovir vs placebo group (difference, –44 mL, 95 percent confidence interval [CI], –150 to 62; p=0.41). However, the valaciclovir group showed reduced sputum white cell count (difference, 2.89x10⁶, 95 percent CI, 1.5x10⁶ to 7.4x10⁶; p=0.003).

The present data support a larger trial to assess long-term clinical outcomes.