Epstein-Barr virus suppression in chronic obstructive pulmonary disease
type: CreativeWork
description: Introduction: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterised by progressive breathlessness and functional decline. This condition is now the third most common cause of global mortality and there are currently no treatments that can meaningfully alter disease progression. EBV has been demonstrated across the severity spectrum of COPD during exacerbations and stable disease using sputum qPCR and immunohistochemistry staining of airway biopsies. In this study we hypothesised that this herpesvirus could represent a novel therapeutic target in COPD. Methods: The EViSCO trial was a single-centre, double-blind, randomised, placebo-controlled trial to determine the safety and efficacy of valaciclovir (1 gram three times daily for 8 weeks) for the suppression of EBV in patients with moderate-to-severe COPD. The primary efficacy outcome was EBV suppression (as defined by a >90% reduction in sputum viral load) at week 8. The primary safety outcome was the incidence of serious adverse reactions (SARs). Secondary outcomes were lung function (FEV1) and drug tolerability. Exploratory outcomes were quality-of-life and sputum biomarkers (cell counts, cytokines, proteases and microbiota). EViSCO is registered on ClinicalTrials.Gov (NCT03699904). Results: In total, 84 participants were randomised (43 to valaciclovir, 41 to placebo), with 81 having sputum EBV formally quantified by PCR before and after treatment (41, valaciclovir). The intention-to-treat analysis found that a higher number of patients experienced sputum EBV suppression in the treatment group (36 (87.8%) vs. 17 (42.5%); p <0.001). Treatment with valaciclovir was associated with a statistically significant reduction in sputum EBV qPCR titre at week 8 (valaciclovir -90404 copies/ml vs. placebo -3940 copies/ml, p=0.002). In the treatment group there was a 24mL numerical increase in the FEV1 at week 8 compared to a 20mL reduction in the control group (difference 44mL (95% CI - 0.15 to …
abstract: Introduction: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterised by progressive breathlessness and functional decline. This condition is now the third most common cause of global mortality and there are currently no treatments that can meaningfully alter disease progression. EBV has been demonstrated across the severity spectrum of COPD during exacerbations and stable disease using sputum qPCR and immunohistochemistry staining of airway biopsies. In this study we hypothesised that this herpesvirus could represent a novel therapeutic target in COPD. Methods: The EViSCO trial was a single-centre, double-blind, randomised, placebo-controlled trial to determine the safety and efficacy of valaciclovir (1 gram three times daily for 8 weeks) for the suppression of EBV in patients with moderate-to-severe COPD. The primary efficacy outcome was EBV suppression (as defined by a >90% reduction in sputum viral load) at week 8. The primary safety outcome was the incidence of serious adverse reactions (SARs). Secondary outcomes were lung function (FEV1) and drug tolerability. Exploratory outcomes were quality-of-life and sputum biomarkers (cell counts, cytokines, proteases and microbiota). EViSCO is registered on ClinicalTrials.Gov (NCT03699904). Results: In total, 84 participants were randomised (43 to valaciclovir, 41 to placebo), with 81 having sputum EBV formally quantified by PCR before and after treatment (41, valaciclovir). The intention-to-treat analysis found that a higher number of patients experienced sputum EBV suppression in the treatment group (36 (87.8%) vs. 17 (42.5%); p <0.001). Treatment with valaciclovir was associated with a statistically significant reduction in sputum EBV qPCR titre at week 8 (valaciclovir -90404 copies/ml vs. placebo -3940 copies/ml, p=0.002). In the treatment group there was a 24mL numerical increase in the FEV1 at week 8 compared to a 20mL reduction in the control group (difference 44mL (95% CI - 0.15 to …
author: Linden, Dermot
language: eng
keywords: COPD, Epstein-Barr virus, valaciclovir, airway inflammation, randomised control trial, lung function
date published: 2022-7
date modified: 2026-07-24T03:56:18Z
provider: Queen's University Belfast
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Queen's University Belfast