Does antiplatelet therapy improve outcomes in patients with chronic kidney disease?

form in 2002. These two RCTs (N5902 and N5954) compared the effect of valacyclovir on herpes labialis recurrence: valacyclovir 2 g twice daily for one day (one-day treatment), valacyclovir 2 g twice daily for one day and then 1 g twice daily for one day (two-day treatment), and placebo. In both trials, patients were instructed to initiate treatment with the first symptoms of a cold sore. Patients were at least 12 years old and had experienced three or more episodes of cold sores in the past year with at least half causing prodromal symptoms. Outcomes included clinician-observed duration of cold sores from initiation of therapy to complete resolution of lesions and patient-reported duration of pain measured from treatment initiation to complete cessation of pain. In the first trial, one-day treatment compared with placebo decreased the lesion duration by 1.1 days (95% CI, –1.6 to –0.6) and two-day treatment compared with placebo decreased the lesion duration by 0.7 days (95% CI, –1.3 to –0.2). In the second trial, one-day treatment compared with placebo decreased the lesion duration by 1.0 day (95% CI, –1.5 to –0.5) and two-day treatment compared with placebo decreased the lesion duration by 0.8 days (95% CI, –1.3 to –0.3). In the first trial, one-day treatment decreased time to cessation of pain by 0.7 days (95% CI, –1.3 to –0.2) compared with placebo, whereas two-day treatment was no different than placebo (mean difference [MD] –0.4 days; 95% CI, –0.9 to 0.1). Similarly, in the second trial, one-day treatment decreased time to cessation of pain by 0.8 days (95%CI, –1.4 to –0.3) compared with placebo, whereas two-day treatment was no different than placebo (MD –0.3 days; 95% CI, –0.8 to 0.2). The authors stated that no difference was observed in outcomes between the one-day and two-day treatments although no statistical analysis was given. The study design failed to describe the method of randomization. A 2006 RCT of 701 immunocompetent adults with recurrent herpes labialis compared famciclovir 1,500 mg (single dose), famciclovir 750 mg twice a day for one day (single day), and placebo. Patients with three or more outbreaks per year were instructed to initiate treatment within one hour of the onset of prodromal symptoms and before the appearance of lesions. The primary endpoint was time to healing of the primary vesicular lesions measured from the start of treatment to investigator-assessed resolution. A secondary endpoint was the duration of pain and the tendernessmeasured fromonset of symptoms to complete resolution. Both the single-dose and single-day treatments compared with placebo decreased the time to healing (4.4 and 4.0 days vs 6.2 days; P,.001 for both comparisons with placebo) but no difference was observed between the single-dose and single-day treatments. The single-dose treatment resulted in faster resolution of pain and tenderness compared with placebo (1.7 vs 2.9 days; P,.001) and compared with the single-day treatment (1.7 vs 2.1 days; P5.046). Time to resolution of pain was not different between the singleday treatment and placebo. Kyle Griffin, MD Cox FMR Springfield, MO The author declares no conflicts of interest.