Zoster Eye Disease Study (ZEDS)

February 21, 2024 updated by: NYU Langone Health

Long-term Suppressive Valacyclovir Treatment for Herpes Zoster Ophthalmicus

This is a multi-center, randomized, double-masked, placebo-controlled clinical trial of suppressive valacyclovir for one year in immunocompetent study participants with an episode of dendriform epithelial keratitis, stromal keratitis, endothelial keratitis, and/or iritis due to Herpes Zoster Ophthalmicus (HZO) in the year prior to enrollment.

Study Overview

Status

Active, not recruiting

Detailed Description

The objective of the Zoster Eye Disease Study (ZEDS) is to determine whether prolonged suppressive oral antiviral treatment with valacyclovir reduces complications of Herpes Zoster Ophthalmicus (HZO), thereby improving clinical outcomes in this common and potentially vision- and life-threatening disease. There are 1,000,000 new cases of Herpes Zoster (HZ) per year in the USA, with 10-20% being HZO.

Specific AIMS

Primary Aim: The primary aim of this double-masked, placebo controlled multicenter randomized clinical trial will test the hypothesis that suppressive antiviral treatment for 12 months with oral valacyclovir 1000 mg daily reduces the rate of new or worsening dendriform epithelial keratitis, stromal keratitis, endothelial keratitis or iritis compared to placebo, at 12 months as the primary endpoint, and at 18 months including 6 months of follow-up after treatment, as a secondary endpoint, in patients with HZO who have had an episode of one of these disease manifestations during the year prior to enrollment.

Secondary AIM: The second aim is to test the hypothesis that suppressive treatment for 12 months with oral valacyclovir 1000 mg daily reduces the severity and duration of postherpetic neuralgia (PHN), compared to placebo, at 12 months and at 18 months as secondary endpoints, in similar patients with HZO. PHN is a debilitating chronic pain syndrome that negatively impacts quality of life, especially in elderly patients.

The study will enroll immunocompetent patients age 18 years and older who have HZO diagnosed at variable times in the past, with these types of active anterior segment ocular segment disease within the past year. Eligible patients will be randomized in a 1:1 ratio to long-term suppressive treatment with oral valacyclovir 1000 mg daily or placebo for 12 months, plus usual ophthalmic care, and followed every 3 months for a total of 18 months, to determine outcomes of new or worsening dendriform epithelial keratitis, stromal keratitis, endothelial keratitis or iritis and/or severity and duration of PHN during 12 months of treatment and for 6 months following treatment discontinuation. The results with regard to PHN may be applicable to HZ in other locations. If suppressive valacyclovir treatment is determined to be effective, the potentially devastating disease burden of HZO and HZ may be reduced for patients, as well as the annual costs to society, estimated in the USA to be one billion dollars.

Study Type

Interventional

Enrollment (Actual)

652

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

    • Alberta
      • Edmonton, Alberta, Canada, T5H 3V9
        • Royal Alexandra Hospital
    • British Columbia
      • Vancouver, British Columbia, Canada, V5Z 3N0
        • University of British Columbia/Vancouver General Hospital Eye Care Centre
    • Ontario
      • Kingston, Ontario, Canada, K7L 5G2
        • Kingston Health Sciences Centre-HDH Site and Queen's University
      • Oakville, Ontario, Canada, L6H 0J8
        • Prism Eye Institute
    • Quebec
      • Montréal, Quebec, Canada, H2X 3E4
        • Centre Hospitalier de l'Universite de Montreal (CHUM)
      • Montréal, Quebec, Canada, H3A 4S5
        • The Research Institute of the McGill University Health Centre/McGill Academic Eye Centre
      • Sherbrooke, Quebec, Canada, J1H4C7
        • Clinique Axe Visuel
    • Alabama
      • Birmingham, Alabama, United States, 35233
        • University of Alabama at Birmingham
    • Arizona
      • Scottsdale, Arizona, United States, 85259
        • Mayo Clinic - Arizona
    • Arkansas
      • Little Rock, Arkansas, United States, 72205
        • University of Arkansas for Medical Sciences
    • California
      • La Jolla, California, United States, 92037
        • Scripps Clinic
      • Loma Linda, California, United States, 92354
        • Loma Linda University Eye Institute
      • Los Angeles, California, United States, 90095
        • Jules Stein Eye Clinic - UCLA
      • Palo Alto, California, United States, 94303
        • Byers Eye Institute at Stanford University
      • San Francisco, California, United States, 94131
        • UCSF- Francis I. Proctor Foundation
      • San Luis Obispo, California, United States, 93401
        • Pacific Eye Surgeons, Inc.
    • Colorado
      • Aurora, Colorado, United States, 80045
        • University of Colorado
      • Littleton, Colorado, United States, 80120
        • Colorado Cornea Consultants P.C.
    • District of Columbia
      • Washington, District of Columbia, United States, 20007
        • Medstar Georgetown University Hospital
    • Florida
      • Delray Beach, Florida, United States, 33484
        • Delray Eye Associates, PA
      • Gainesville, Florida, United States, 32610
        • University of Florida
      • Jacksonville, Florida, United States, 33204
        • Florida Eye Specialists
      • Miami, Florida, United States, 33136
        • University of Miami - Bascom Palmer Eye Institute
    • Georgia
      • Atlanta, Georgia, United States, 30339
        • Eye Consultants of Atlanta, PC
    • Illinois
      • Chicago, Illinois, United States, 60612
        • University of Illinois
      • Glenview, Illinois, United States, 60026
        • Northshore University Health System
    • Indiana
      • Cleveland, Indiana, United States, 44106
        • Case Western Reserve University
      • Indianapolis, Indiana, United States, 46202
        • Indiana University - Glick Eye Institute
    • Kansas
      • Prairie Village, Kansas, United States, 66208
        • University of Kansas Medical Center
    • Kentucky
      • Lexington, Kentucky, United States, 40509
        • University of Kentucky
    • Louisiana
      • New Orleans, Louisiana, United States, 70112
        • LSU Health Science Center
      • Shreveport, Louisiana, United States, 71106
        • Shreveport Eye Clinic
    • Maryland
      • Baltimore, Maryland, United States, 21201
        • University of Maryland
      • Baltimore, Maryland, United States, 21215
        • The Krieger Eye Institute
      • Bethesda, Maryland, United States, 20817
        • Wilmer Eye Institute John Hopkins
      • Owings Mills, Maryland, United States, 21117
        • Crossroads Eye Physician
    • Massachusetts
      • Boston, Massachusetts, United States, 02114
        • Massachusetts Eye and Ear Infirmary
      • Boston, Massachusetts, United States, 02111
        • Tufts Medical Center
      • Boston, Massachusetts, United States, 02118
        • Boston Medical Center
      • Peabody, Massachusetts, United States, 01960
        • Lahey Medical Center
      • Weymouth, Massachusetts, United States, 02189
        • Eye Health Services
    • Michigan
      • Ann Arbor, Michigan, United States, 48105
        • University of Michigan
      • Grand Rapids, Michigan, United States, 49546
        • Verdier Eye Center
    • Minnesota
      • Golden Valley, Minnesota, United States, 55427
        • Northwest Eye Clinic
      • Minnetonka, Minnesota, United States, 55305
        • Jennifer Burdick
      • Rochester, Minnesota, United States, 55905
        • Mayo Clinic
    • Missouri
      • Saint Louis, Missouri, United States, 63110
        • Washington University Opthalmology
    • New Hampshire
      • Lebanon, New Hampshire, United States, 03756
        • Dartmouth Hitchcock Medical Center
    • New Jersey
      • Morristown, New Jersey, United States, 07960
        • EyeCare MD of NJ
    • New York
      • Albany, New York, United States, 12208
        • Albany Stratton VA Medical Center
      • Canandaigua, New York, United States, 14424
        • Finger Lakes Ophthalmology /The Eye Care Center
      • East Setauket, New York, United States, 11733
        • Stony Brook Ophthalmology
      • Great Neck, New York, United States, 11021
        • Northwell Health
      • New York, New York, United States, 10016
        • NYU Langone Health
      • New York, New York, United States, 10003
        • New York Eye and Ear Infirmary
      • New York, New York, United States, 10021
        • Weill Cornell Ophthalmology
    • North Carolina
      • Durham, North Carolina, United States, 27710
        • Duke University
    • Ohio
      • Cincinnati, Ohio, United States, 45242
        • Cincinnati Eye Institute
      • Cleveland, Ohio, United States, 44106
        • Case Western Reserve University
    • Oregon
      • Portland, Oregon, United States, 97210
        • Devers Eye Institute
      • Portland, Oregon, United States, 97239
        • Casey Eye Institute - Oregon Health and Science University
    • Pennsylvania
      • Bala-Cynwyd, Pennsylvania, United States, 19004
        • Vantage Eye Care Center, LLC
      • Danville, Pennsylvania, United States, 17822
        • Geisinger Eye Clinic
      • Philadelphia, Pennsylvania, United States, 19104
        • University of Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19107
        • Corneal Associates at Wills Eye Hospital
    • Tennessee
      • Memphis, Tennessee, United States, 38163
        • University of Tennessee - Hamilton Eye Institute
      • Nashville, Tennessee, United States, 37232
        • Vanderbilt Eye Institute
      • Nashville, Tennessee, United States, 37203
        • Cornea and Cataract Consultants of Nashville
    • Texas
      • Dallas, Texas, United States, 75390
        • University of Texas Southwestern
      • Dallas, Texas, United States, 75231
        • Cornea Associates of Texas
      • Fort Worth, Texas, United States, 76107
        • Cornea Consultants of Texas
      • Houston, Texas, United States, 77030
        • Alkek Eye Center - Baylor College of Medicine
      • San Antonio, Texas, United States, 78229
        • R and R Eye Research, LLC
    • Utah
      • Salt Lake City, Utah, United States, 84132
        • University of Utah - Moran Eye Center
    • Virginia
      • Richmond, Virginia, United States, 23226
        • Virginia Eye Institute
    • Washington
      • Seattle, Washington, United States, 98101
        • Virginia Mason Medical Center
      • Seattle, Washington, United States, 98133
        • NY Eye Surgeons
    • Wisconsin
      • Madison, Wisconsin, United States, 53705
        • University of Wisconsin - Madison

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

PARTICIPANT INCLUSION CRITERIA

To be eligible for study participation, an individual must meet all of the following criteria:

  1. Ability to understand, and willingness and ability to read and sign, the informed consent form.
  2. Ability to understand and follow instructions and study procedures.
  3. Willingness to comply with all study procedures and be available for the duration of the study.
  4. Ability to take oral medication, and are willing to adhere to study medication regimen.
  5. Age 18 years or older.
  6. Diagnosed with HZO in one eye based on both of these criteria:

    1. History of characteristic unilateral, usually vesicular, HZO rash in the dermatomal distribution of cranial nerve V1 or V2.
    2. Medical record documentation of an episode of active dendriform epithelial keratitis, stromal keratitis, endothelial keratitis, and/or iritis due to HZO within the preceding year. This episode of active anterior segment ocular disease may be due to HZO of recent onset (within the preceding 6 months); or chronic HZO (with onset six or more months ago); may be new, worsening, or recurrent disease after a period of inactivity; and may occur after medication was reduced.

    i. Study participants with chronic HZO must be on a stable treatment regimen and off antivirals for at least 30 days before enrollment. Study participants with chronic HZO who do not meet this criterion may be rescreened, if they are able to meet this criterion within 3 months after the study visit. This is not a requirement for study participants with recent onset HZO, who may be enrolled at any time, preferably after completing recommended acute antiviral treatment, if prescribed, is completed. They can be on variable dose of steroids, and only need to be off oral and topical antivirals by the enrollment visit.

  7. For females with reproductive potential, willingness to use highly effective contraception (e.g., hormonal contraception, barrier contraception, intrauterine device, or abstinence).

PARTICIPANT EXCLUSION CRITERIA

An individual who meets any of the following criteria will be excluded from participation in this study:

  1. History of immunocompromised status as defined by current CDC contraindications for the vaccine against zoster (44).

    1. Study participants who are diagnosed with leukemia, lymphomas or other malignant neoplasms affecting bone marrow or lymphatic system, unless leukemia in remission and off chemotherapy for at least 3 months.
    2. Study participants who are diagnosed with Acquired Immune Deficiency Syndrome (AIDS) or presents with other clinical manifestations of Human Immunodeficiency virus (HIV) including CD4 count of ≤ 200 cells/ml.
    3. Study participants on immunosuppressive therapy including:

    i. High-dose corticosteroids (greater than equivalent of prednisone 20 mg/day within 1 month) ii. Chemotherapy, other than low dose used for treatment of immune-mediated diseases within 3 months iii. Study participants receiving recombinant human immune mediators and immune modulators, especially antitumor necrosis agents, within 1 month prior to enrollment d. Study participants with unspecified cellular immunodeficiency. e. Study participants with history of hematopoietic stem cell transplantation.

  2. Medical history of a systemic disease and thought likely to meet one of the exclusion criteria listed in exclusion criterion #1 during the 18-month study period.
  3. Renal insufficiency:

    1. Requires dialysis or has history of renal transplant or
    2. eGFR less than 45, determined within 3 months days preceding enrollment.
  4. Allergy or adverse reaction to valacyclovir or acyclovir.
  5. History of vaccination against zoster within one month prior to enrollment. Study participants who meet this exclusion criterion may be may be screened and enrollment delayed until eligible within 3 months. If the study participant receives the Herpes Zoster Subunit vaccine (Recombinant Zoster Vaccine (RZV), Shingrix), rescreening should take place one month after the second required dose of the vaccine.
  6. Keratorefractive surgery, other than limbal relaxing incisions or astigmatic keratotomies at the time of cataract surgery, within 5 years of enrollment, or keratoplasty of the involved eye with zoster.
  7. On systemic antivirals with activity against herpes within the past 30 days, including acyclovir, valacyclovir, or famciclovir, for any reason except for treatment of recent onset HZO, including investigational drug trial.
  8. History of another condition that may require treatment with one of these three antivirals listed above in exclusion criterion #7, during the course of the study; study participants who require chronic suppressive antiviral treatment with these medications will be excluded.
  9. Sexually active women who are pregnant, nursing, or in their reproductive years who do not agree to use contraception during the 1-year treatment period.
  10. Incarceration
  11. Any condition or circumstance that in the opinion of the study investigator, would place the study participant in increased risk or affect his/her full compliance or completion of the study.
  12. Participation in a clinical study testing a drug, biologic, device or other intervention within the last 30 days from enrollment visit. Study participants who meet this criterion may be rescreened.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Placebo Comparator: Placebo
Encapsulated masked placebo
Oral Placebo
Active Comparator: Masked Oral Valacyclovir 1000 mg daily
Valacyclovir, 500 mg, oral pill, two 500mg pills daily
Oral Valacyclovir 1000 mg/day
Other Names:
  • Valtrex

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time to first occurrence of Dendriform epithelial keratitis, Stromal keratitis, Endothelial keratitis or Iritis
Time Frame: 12 months
The primary outcome measure is time to first occurrence of Dendriform epithelial keratitis, Stromal keratitis, Endothelial keratitis,OR Iritis, associated with pre-specified definitions of these disease manifestations and associated treatment requirements, in study participants assigned to valacyclovir compared to placebo, during one year of study treatment.
12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Study Chair: Elisabeth Cohen, MD, NYU Langone Health

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 23, 2017

Primary Completion (Actual)

December 31, 2023

Study Completion (Estimated)

July 31, 2024

Study Registration Dates

First Submitted

April 26, 2017

First Submitted That Met QC Criteria

April 26, 2017

First Posted (Actual)

April 28, 2017

Study Record Updates

Last Update Posted (Actual)

February 23, 2024

Last Update Submitted That Met QC Criteria

February 21, 2024

Last Verified

February 1, 2024

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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