Efficacy and Safety of Amenamevir, a Helicase-Primase Inhibitor for the Treatment of Acyclovir-Resistant Herpes Simplex Virus 1 Keratitis.

IF 1.9 3区医学 Q2 OPHTHALMOLOGY Cornea Pub Date : 2025-01-01 Epub Date: 2024-04-25 DOI:10.1097/ICO.0000000000003553

Rafael Boucher, David Boutolleau, Sonia Burrel, Oscar Haigh, José Fernandez, Christelle Vauloup-Fellous, Emmanuel Barreau, Antoine Rousseau, Marc Labetoulle

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Abstract

Purpose: The purpose of this study was to describe the efficacy and tolerance of amenamevir (AMNV), an inhibitor of the viral helicase-primase, for the treatment of recalcitrant herpes simplex keratitis (HSK) caused by acyclovir-resistant (ACVR) herpes simplex virus 1 strains.

Methods: In this retrospective case series, 6 consecutive patients with HSK caused by an ACVR herpes simplex virus 1 strain with a failure of conventional antiviral therapy were included after having been treated with AMNV (there was no control group of comparable patients for whom previous treatment would have been continued despite its inefficacy). Medical files were assessed for clinical data including reason(s) for AMNV introduction (frequent recurrences despite appropriate preventive antiviral treatment and/or clinical resistance to suppressive antiviral treatment of an ongoing clinical relapse), genotypical resistance to herpes simplex virus 1 documentation, immune status, clinical types and number of HSK episodes before and during AMNV treatment, adverse effects observed during AMNV treatment, and best corrected visual acuity.

Results: Of 6 patients, 4 (66%) did not experience a single recurrence during AMNV therapy while 2 others had recurrences (1 over 24 months of treatment and 2 over 23 months, ie two-fold less frequently than with conventional preventive treatment). On the overall history of these 6 patients, AMNV appeared to be associated with a reduction in HSK recurrences, with a mean of only 0.02 ± 0.04 episodes/month during follow-up under AMNV as compared to 0.14 ± 0.04 episodes/month in the year preceding AMNV introduction ( P = 0.03). Improvement in vision acuity was also observed (mean best corrected visual acuity 0.17 ± 0.12 logarithm of the minimum angle of resolution at the end of follow-up vs. 0.30 ± 0.35 before AMNV onset), albeit nonsignificant probably due to the limited number of patients ( P = 0.38). Neither clinical nor biological adverse effects were observed while under AMNV during the follow-up (16.5 ± 5.8 months).

Conclusions: Although there was no control group, AMNV may be a valuable option to reduce ACVR HSK recurrences.

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螺旋酶-蛋白酶抑制剂阿美那韦治疗耐药阿昔洛韦疱疹病毒 1 角膜炎的疗效和安全性。

目的：本研究的目的是描述阿米那韦（AMNV）治疗由阿昔洛韦耐药（ACVR）的单纯疱疹病毒1株引起的顽固性单纯疱疹性角膜炎（HSK）的疗效和耐受性：在这一回顾性病例系列中，连续纳入了 6 例由 ACVR 单纯疱疹病毒 1 株引起的 HSK 患者，他们都曾接受过 AMNV 治疗，但常规抗病毒治疗均告失败（没有可比患者对照组，尽管之前的治疗无效，但仍会继续治疗）。对医疗档案中的临床数据进行了评估，包括使用 AMNV 的原因（尽管进行了适当的预防性抗病毒治疗，但仍频繁复发，和/或对正在进行的临床复发的抑制性抗病毒治疗产生临床耐药性）、对单纯疱疹病毒 1 文件的基因型耐药性、免疫状态、AMNV 治疗前和治疗期间 HSK 的临床类型和发作次数、AMNV 治疗期间观察到的不良反应以及最佳矫正视力：6名患者中，有4人（66%）在AMNV治疗期间没有复发过一次，另外2人复发过（1人在治疗24个月后复发，2人在治疗23个月后复发，即复发频率比传统预防性治疗低2倍）。从这6名患者的总体病史来看，AMNV似乎与HSK复发率降低有关，在AMNV治疗期间，平均每月仅复发0.02±0.04次，而在采用AMNV治疗前一年，平均每月复发0.14±0.04次（P = 0.03）。此外，还观察到视力的改善（随访结束时的平均最佳矫正视力为 0.17 ± 0.12 最小解像角对数，而 AMNV 使用前为 0.30 ± 0.35），但可能由于患者人数有限，改善并不显著（P = 0.38）。在随访期间（16.5 ± 5.8 个月），AMNV 未对临床和生物学产生不良影响：虽然没有对照组，但 AMNV 可能是减少 ACVR HSK 复发的一个有价值的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cornea 医学-眼科学

CiteScore

5.20

自引率

10.70%

发文量

354

审稿时长

3-6 weeks

期刊介绍： For corneal specialists and for all general ophthalmologists with an interest in this exciting subspecialty, Cornea brings together the latest clinical and basic research on the cornea and the anterior segment of the eye. Each volume is peer-reviewed by Cornea''s board of world-renowned experts and fully indexed in archival format. Your subscription brings you the latest developments in your field and a growing library of valuable professional references. Sponsored by The Cornea Society which was founded as the Castroviejo Cornea Society in 1975.