Valacyclovir Treatment of Early Symptomatic Alzheimer Disease

Can valacyclovir, an antiviral medication effective against herpes simplex virus, which has been implicated in the pathogenesis of Alzheimer disease, be repurposed to provide clinical benefit in patients with early symptomatic Alzheimer disease?In this randomized clinical trial that included 120 participants with early symptomatic Alzheimer disease and herpes simplex seropositivity, the least-squares mean change in the 11-item Alzheimer’s Disease Assessment Scale Cognitive Subscale score (range, 0-70; higher scores indicate greater impairment) at 78 weeks was 10.86 in the valacyclovir group vs 6.92 in the placebo group, which was a significant difference favoring placebo.Valacyclovir was not efficacious with cognitive worsening for the primary outcome and it is not recommended to treat individuals with early symptomatic Alzheimer disease and herpes simplex virus seropositivity.

Corresponding Author: D. P. Devanand, MD, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032 (dpd3@cumc.columbia.edu).

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