Xuemin Wang, Huan Shi, Suwei Tang, Yang Yang, Qi Zheng, Wencheng Jiang

Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, People’s Republic of China

Correspondence: Wencheng Jiang, Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, 1278 Baode Road, Jing’ an District, Shanghai, 200443, People’s Republic of China, Tel +86 21 3680 3139, Email drjiangwencheng@163.com

Purpose: Herpes zoster poses severe complications in elderly immunocompromised patients, particularly those with altered drug metabolism and renal impairment, impacting quality of life.
Patients and Methods: To evaluate brivudine’s efficacy and safety in such cases, we conducted a retrospective case series at Shanghai Skin Disease Hospital, analyzing four Chinese patients (aged 64– 84 years) with complex herpes zoster, including systemic lupus erythematosus, diabetes nephropathy, multiple comorbidities, and trigeminal nerve involvement. Selected for their immunocompromised status and prior antiviral failure or renal concerns, patients received oral brivudine (125 mg once daily) with or without intravenous acyclovir, with outcomes assessed via clinical examination, pain scores, and laboratory monitoring over 7– 14 days.
Results: All patients experienced rapid symptom relief, lesion resolution, and pain reduction with minimal side effects. Compared to previous use of other antivirals, brivudine was better tolerated and did not require renal dose adjustment.
Conclusion: In summary, brivudine appears to be a promising option for elderly immunocompromised patients with herpes zoster, offering effective viral control, favorable safety, and improved clinical outcomes.
Plain Language Summary: Brivudine is effective in immunocompromised and elderly patients and yields better results than acyclovir or valaciclovir, particularly in patients with severe or disseminated herpes zoster.Brivudine has a favorable safety profile in patients with renal impairment, unlike acyclovir and valacyclovir, which can accumulate and cause toxicity.Early antiviral therapy can lead to rapid symptom relief, lesion resolution, and pain management, particularly in patients with high risk.Combining brivudine with pain management (eg, pregabalin and mecobalamin) enhances treatment outcomes in complex cases.

Keywords: antivirals, brivudine, case report, herpes zoster, immunocompromised, older Chinese adults