valacyclovir / Generic mfg. - LARVOL DELTA

Herpes Zoster and Postherpetic Neuralgia: Common Questions and Answers. (PubMed, Am Fam Physician) - "Treatment for herpes zoster involves antiviral medications (eg, acyclovir, valacyclovir, famciclovir) with or without adjunctive pain management. Two doses of recombinant zoster vaccine are recommended for adults 50 years and older and those 19 years and older with immunocompromise. Obstacles to receiving vaccination include low awareness, administration errors, necessity of receiving multiple doses, and vaccine adverse effects."

Journal • Review • Herpes Zoster • Infectious Disease • Musculoskeletal Pain • Neuralgia • Pain • Varicella Zoster

A Case on VZV Hepatitis and Autoimmune Hepatitis in an Immunocompetent Patient (ACG 2026) - "Following a positive VZV immunohistochemical stain, the treatment regimen was adjusted to prednisone, and intravenous acyclovir was initiated for VZV hepatitis. She was discharged with azathioprine, steroids, and valacyclovir for autoimmune hepatitis and VZV hepatitis...B: Trichrome stain notable for significant fibrosis consistent with cirrhosis. C: VZV immunohistochemistry stains positive for VZV antigens."

Clinical • Addiction (Opioid and Alcohol) • Autoimmune Hepatitis • Fibrosis • Hematological Disorders • Hepatology • Herpes Zoster • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Liver Failure • Nephrology • Varicella Zoster

Unmasked by Steroids: CMV Colitis Mimicking IEC-Enterocolitis After CAR-T Therapy (ACG 2026) - "Case Description/ A 48-year-old male with relapsed/refractory diffuse large B-cell lymphoma received CAR-T therapy (axicabtagene ciloleucel)...11 weeks post-infusion, he presented with sepsis requiring stress-dose hydrocortisone...Due to the high mortality of IEC-EC, IV steroids were started until CMV immunostaining returned with numerous inclusions and CMV PCR from HD2 resulted at 316,000 IU/mL (HD 11); valganciclovir was initiated...Standard valacyclovir prophylaxis has no CMV activity yet may create false reassurance...(A) H&E stain showing crypt dropout, apoptotic bodies - features that overlap with both CMV colitis and IEC-EC, and were initially interpreted as a GVHD/IEC-EC pattern of injury. (B) CMV immunohistochemical stain with numerous positive cells (brown) confirming the diagnosis of CMV colitis."

CAR T-Cell Therapy • B Cell Lymphoma • Cytomegalovirus Infection • Diffuse Large B Cell Lymphoma • Gastroenterology • Gastrointestinal Disorder • Graft versus Host Disease • Hematological Malignancies • Immunology • Infectious Disease • Lymphoma • Non-Hodgkin’s Lymphoma • Septic Shock

Disseminated Herpes Simplex Virus Infection With Esophagitis in a Patient With Crohn's Disease on Anti-TNF Monotherapy (ACG 2026) - "Case Description/ A 43-year-old woman with ileal stricturing and fistulizing Crohnâs disease (A3L1B2) on weekly adalimumab presented with 5 days of worsening headache, oral ulcers, epigastric pain with odynophagia, diarrhea, and 1 day of fever...Due to a national shortage of acyclovir, she was transitioned to intravenous ganciclovir, followed by oral valacyclovir...Although ganciclovir is not FDA-approved for HSV, in vitro data confirm excellent anti-HSV activity, supporting its potential utility when standard therapy is unavailable. Figure: Lower Third of the Esophagus on Endoscopy"

Clinical • Monotherapy • CNS Disorders • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Herpes Simplex • Immunology • Infectious Disease • Inflammatory Bowel Disease • Leukopenia • Thrombocytopenia

Rare Esophageal Involvement of Post-Transplant Lymphoproliferative Disorder (ACG 2026) - "Case Description/ A 70 year-old male with a history of pulmonary fibrosis and pulmonary hypertension status post lung transplant on tacrolimus, valacyclovir and sulfamethoxazole/trimethoprim, presented with hematochezia. He was recently diagnosed with PTLD, and was also on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)...B: Mucosa suggestive of Barrett's with nodule. C: Ulcerated mucosa in the terminal ileum."

Post-transplantation • Barrett Esophagus • Cardiovascular • Epstein-Barr Virus Infections • Gastrointestinal Disorder • Hematological Malignancies • Hypotension • Immunology • Lymphoma • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • T Cell Non-Hodgkin Lymphoma • Transplantation

Ramsay Hunt Syndrome Following Vedolizumab Initiation in Refractory Ulcerative Colitis (ACG 2026) - "He was treated with intravenous methylprednisolone and valacyclovir followed by oral prednisone and valacyclovir at discharge. His UC had been refractory to multiple therapies including infliximab and a recent 3-year course of tofacitinib...Vedolizumab was discontinued, and he was transitioned to risankizumab-rzaa with improved UC control and weight gain...Figure: Figure 1. White-mucocutaneous lesions on the right side of the patientâs hard palate, consistent with Ramsay Hunt Syndrome."

Cardiovascular • CNS Disorders • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hematological Disorders • Herpes Zoster • Immunology • Infectious Disease • Inflammatory Bowel Disease • Otorhinolaryngology • Ulcerative Colitis • Varicella Zoster

Dysphagia Before Steroids: HSV-1 Esophagitis Preceding Immunosuppression in Bullous Pemphigoid (ACG 2026) - "Dermatologic evaluation and skin biopsy confirmed bullous pemphigoid, and oral prednisone was started on March 13 with improvement in skin lesions...Treatment with intravenous acyclovir followed by oral valacyclovir resulted in marked improvement in dysphagia and oral intake...Age-related immune senescence and immune dysregulation associated with bullous pemphigoid may increase susceptibility to HSV reactivation. Clinicians should maintain suspicion for infectious esophagitis in elderly patients with progressive dysphagia, as early endoscopic evaluation with biopsy remains essential for timely diagnosis and antiviral treatment."

Acute Coronary Syndrome • Acute Kidney Injury • Bullous Pemphigoid • Dermatology • Dermatopathology • Endometrial Cancer • Gastrointestinal Disorder • Gynecology • Heart Failure • Herpes Simplex • Human Immunodeficiency Virus • Immunology • Infectious Disease • Metabolic Disorders • Nephrology • Renal Disease • Solid Tumor • Ventricular Tachycardia

Disseminated Gastrointestinal Histoplasmosis in an Immunocompromised Patient (ACG 2026) - "Case Description/ We present a 31-year-old female with history of spondyl-arthropathy on adalimumab since 2016, herpes simplex virus type 2 on valacyclovir that was admitted for progressive post-prandial abdominal pain, nausea, vomiting, hematochezia, and flu-like symptoms for 3 months...She started enteral itraconazole with trough levels monitored closely...Figure: Axial CT Abdomen/Pelvis view. Visually emphasizes the extent of obstruction seen in patient's case."

Clinical • Gastrointestinal Disorder • Herpes Simplex • Immunology • Infectious Disease • Pneumonia • Respiratory Diseases • Sarcoidosis • Spondylarthritis

Renal Manifestations in Crohn's Disease: A Case of IgA Nephropathy (ACG 2026) - "Case Description/ A 20-year-old woman with longstanding ileocolonic CD diagnosed in childhood and comorbid psoriasis was in endoscopic remission on adalimumab but transitioned to risankizumab in the past year, remaining clinically stable...She was treated with prednisone and valacyclovir...CT abdomen/pelvis was unremarkable, and she received cephalexin for presumed UTI...It is possible that the viral infection causing Bellâs palsy triggered an immune cascade leading to IgAN. In patients with Crohnâs disease and psoriasis presenting with unexplained proteinuria and hematuria, IgAN should be a key consideration, and early collaboration with Nephrology is critical."

Clinical • CNS Disorders • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Glomerulonephritis • IgA Nephropathy • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Nephrology • Psoriasis • Renal Disease

Advanced Endoscopic Features of Severe HSV Esophagitis in an Immunocompromised Host (ACG 2026) - "Her medical history was notable for metastatic ovarian cancer on third-line chemotherapy, stage 3 diffuse large B-cell lymphoma treated with R-CHOP, and deep vein thrombosis treated with an IVC filter and rivaroxaban...The patient was started on pantoprazole twice daily...She was later evaluated by an infectious disease consultant who recommended continuing valacyclovir for prophylaxis while immunosuppressed...Figure: Figure 1. Upper endoscopy showing severe esophagitis starting in the mid-esophagus (A) and extending distally (B,C) to the gastroesophageal junction (not shown)"

Metastases • B Cell Lymphoma • Bone Marrow Transplantation • Diffuse Large B Cell Lymphoma • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hematological Malignancies • Herpes Simplex • Human Immunodeficiency Virus • Infectious Disease • Lymphoma • Non-Hodgkin’s Lymphoma • Ovarian Cancer • Solid Tumor • Thrombosis

Atypical Endoscopic Findings of HSV Esophagitis in an Immunocompetent Patient (ACG 2026) - "She is initially treated with famotidine without significant symptomatic relief...Patient is treated with pantoprazole and sucralfate and referred to infectious disease...Early recognition is important because antiviral therapy with acyclovir or valacyclovir may shorten symptom duration and accelerate recovery. Figure: Image 1: Upper endoscopy showing erosive esophagitis at the distal esophagus, with pathology later revealing HSV esophagitis. Figure: Image 2: Another endoscopic view of the HSV esophagitis."

Clinical • CNS Disorders • Epilepsy • Gastrointestinal Disorder • Herpes Simplex • Infectious Disease • Inflammation

Varicella-Zoster Virus Meningitis in a Patient Treated With Dupilumab for Eosinophilic Esophagitis: A Case Report (ACG 2026) - "Dupilumab was discontinued, and the patient was treated with intravenous acyclovir followed by oral valacyclovir to complete a 14-day antiviral course, with full neurologic recovery. VZV meningitis may represent a rare but serious complication of dupilumab therapy in EoE. Clinicians should maintain a high index of suspicion for VZV CNS infection in patients receiving dupilumab who present with new neurologic symptoms, even in the absence of a characteristic rash."

Case report • Clinical • Atopic Dermatitis • CNS Disorders • Dermatitis • Eosinophilia • Eosinophilic Esophagitis • Gastrointestinal Disorder • Herpes Zoster • Immunology • Infectious Disease • Varicella Zoster • IL13 • IL4 • IL4R

Varicella Zoster Virus-Associated Segmental Colitis Presenting as Hematochezia (ACG 2026) - "GI symptoms and rash resolved with continued valacyclovir...(B) Three months after completion of acyclovir therapy, demonstrating complete mucosal healing and resolution of inflammation. Figure: Figure 2. Cutaneous herpetic eruption involving the right L1 dermatome, characterized by clustered erythematous vesicles in a unilateral dermatomal distribution."

Gastroenterology • Gastrointestinal Disorder • Herpes Zoster • Immunology • Inflammation • Varicella Zoster

Varicella-Zoster Immune Reconstitution Inflammatory Syndrome in HIV-Infected Patient (ACG 2026) - "The patient was treated with prednisone, N-acetylcysteine, valacyclovir, and atovaquone with improvement in liver enzymes. Diagnosis relies on temporal association with ART, evidence of immune recovery, clinical deterioration from inflammatory response, and exclusion of competing etiologies. This case highlights the importance of monitoring liver enzymes after ART initiation and maintaining suspicion for atypical manifestations of IRIS, particularly in severely immunocompromised patients with concurrent opportunistic infections."

Clinical • Autoimmune Hepatitis • CNS Disorders • Hepatitis B • Hepatology • Herpes Zoster • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Pneumonia • Respiratory Diseases • Septic Shock • Varicella Zoster • CD4

Herpetic Esophagitis: An Uncommon Diagnosis in Immunocompetent Patients (ACG 2026) - "Treatment includes acyclovir or valacyclovir either in oral or IV route, depending on symptom severity. Figure: Endoscopic imaging of the distal esophagus with circumferential ulceration. Figure: Positive herpes simplex virus immunohistochemistry stain."

Clinical • Addiction (Opioid and Alcohol) • Alcoholic Fatty Liver Disease • Cardiomyopathy • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Herpes Simplex • Herpes Zoster • Human Immunodeficiency Virus • Immunology • Infectious Disease • Varicella Zoster

An Unusual Endoscopic Presentation of HSV Esophagitis in an Immunocompetent Host (ACG 2026) - "The patient was referred to infectious disease and received treatment with valacyclovir 1g BID for 14 days, with repeat endoscopy confirming resolution of HSV infection...AI software was used for grammatical clarity in the writing of this abstract. Figure: Endoscopic views of esophageal HSV ulcerations notable for multifocal, circular, clean-based, shallow ulcerations throughout the mid and distal esophagus."

Gastrointestinal Disorder • Hematological Disorders • Herpes Simplex • Infectious Disease

A Malignant Mimic: HSV Esophagitis in an Immunocompetent Patient (ACG 2026) - "He was started on Valacyclovir, pantoprazole, and famotidine. Endoscopic biopsy can establish a treatable diagnosis and help avoid unnecessary oncologic evaluation. Figure: Nodular mucosa at the GE junction (left), LA Grade D esophagitis (right) Figure: Circumferential distal esophageal wall thickening with paraesophageal lymphadenopathy (left), Immunohistochemical stain for HSV-1 highlights the virally infected squamous cells (right)"

Clinical • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Cancer • Gastrointestinal Disorder • Herpes Simplex • Human Immunodeficiency Virus • Immunology • Infectious Disease • Solid Tumor • Vitiligo

Herpes zoster of undetermined strain in a 14-month-old girl presenting 65 days following live-attenuated varicella-zoster vaccination: A case report. (PubMed, IDCases) - "Weight-adjusted oral valacyclovir was initiated at 200 mg four times daily for seven days...Clinicians should include HZ in the differential diagnosis when they encounter a unilateral vesicular eruption in an immunocompetent infant with no history of varicella. DermaQuick, a simple and minimally invasive method, is extremely useful for rapidly diagnosing such cases."

Journal • Dermatology • Herpes Zoster • Varicella Zoster

Overall survival after treatment with CAN-2409 plus valacyclovir in combination with continued ICI in patients with stage III/IV NSCLC with an inadequate response to ICI. (ASCO 2024) - P2 | "Baseline treated pt median age was 67 [43-88] yrs, 44% female, 68% on aPD(L)1 alone and 32% aPD(L)1 + pemetrexed regimen. Experimental treatment with CAN-2409+valacyclovir in NSCLC pts following an inadequate response to ICI is well tolerated and results in the induction of a cytotoxic and memory circulating T cell response associated with shrinkage of injected and uninjected lesions and a raised tail of the survival curve. mOS of the evaluable population was estimated as 22.0m, markedly longer than the expected mOS of 11.6-14.5m."

Clinical • Combination therapy • IO biomarker • Lung Cancer • Non Small Cell Lung Cancer • Oncology • Solid Tumor • CD4 • CD8 • GZMB • IFNG

P2s: Practice-changing, Paradigm-shifting Clinical Trials in Urology: Extended follow-up shows accumulating benefit for patients treated with CAN-2409+prodrug in combination with standard of care external beam radiation (EBRT) in men with localized prosta (AUA 2026) - P3 | "Aglatimagene, a replication-defective adenovirus encoding HSV-tk, combined with valacyclovir (prodrug), induces immunogenic cell death. Aglatimagene significantly improved PCa-specific DFS when added to SoC EBRT±ADT. Further exploratory analyses after extended follow-up show accumulating benefit for PCa-specific clinical outcomes. If approved, aglatimagene could represent a new therapy for pts treated with EBRT with curative intent for localized PCa."

Clinical • Combination therapy • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • Urology

Aglatimagene besadenovec (CAN-2409) with radiotherapy for patients with localised prostate cancer: a phase 3, multicentre, randomised, double-blind, placebo-controlled trial. (PubMed, Lancet Oncol) - P3 | "Aglatimagene plus valacyclovir was associated with longer disease-free survival than placebo plus valacyclovir when added to standard of radiotherapy for the treatment of localised prostate cancer, offering a meaningful benefit without increasing clinically significant toxicity."

Journal • P3 data • Acute Kidney Injury • Dermatology • Genito-urinary Cancer • Infectious Disease • Influenza • Nephrology • Oncology • Prostate Cancer • Renal Disease • Respiratory Diseases • Solid Tumor

Phase 3, randomized, placebo-controlled clinical trial of CAN-2409+prodrug in combination with standard of care external beam radiation (EBRT) for newly diagnosed localized prostate cancer. (ASCO 2025) - P3 | "CAN-2409 is a replication-defective adenovirus encoding the HSV-tk gene that, when combined with valacyclovir (prodrug), results in immunogenic cell death. In this randomized, double-blind, Phase 3 trial, CAN-2409 significantly reduced the risk of PrCa recurrence or death when added to SoC EBRT+/- ADT. The addition of CAN-2409 was not associated with significant added toxicity. These data represent the first potentially new therapy for patients with intermediate and high risk PrCa in over 20 years."

Clinical • Combination therapy • P3 data • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

CAN-2409 With Continued Immune Checkpoint Inhibitor (ICI) in Patients With Stage III/IV NSCLC With Inadequate Response to ICI (IASLC-WCLC 2025) - "Introduction : We previously reported local and systemic immune activation associated with encouraging overall survival (OS) data after two intra-tumoral injections of CAN-2409 plus prodrug (valacyclovir) in patients with unresectable, stage III/IV non-small cell lung cancer (NSCLC), after inadequate response to immune checkpoint inhibitors (ICI). This data supports the rationale for a larger, randomized, controlled clinical trial of CAN-2409 in pts with non-squamous histology with advanced NSCLC, after progression on ICI. treatment."

Checkpoint inhibition • Clinical • IO biomarker • Lung Cancer • Lung Non-Squamous Non-Small Cell Cancer • Non Small Cell Lung Cancer • Oncology • Solid Tumor

First report of safety/tolerability and preliminary antitumor activity of CAN-2409 in inadequate responders to immune checkpoint inhibitors for stage III/IV NSCLC. (ASCO 2022) - P2 | "Two doses of CAN-2409 (5x1011 vp) are given 5-7w apart via bronchoscopic or percutaneous injection into a lung tumor, disease-positive lymph node or peripheral metastasis, followed by valacyclovir...Median age was 70 years; 86% stage IV; 32% squamous; 11% PD-L1 >50%; 82% receiving pembrolizumab and 18% nivolumab... The addition of CAN-2409 for patients with advanced NSCLC and inadequate response to front-line ICI (± chemo) appears to be well tolerated. Preliminary clinical data suggest that CAN-2409 induced a clinical response in 4/14 evaluable patients and produced disease stabilization in most patients entering the trial with PD, with evidence of abscopal effect in a subset of patients."

Checkpoint inhibition • Clinical • IO biomarker • Fatigue • Immune Modulation • Inflammation • Lung Cancer • Non Small Cell Lung Cancer • Oncology • Solid Tumor • CD8 • PD-L1

A Biomarker Study in Men With Localized Prostate Cancer Treated With Aglatimagene Besadenovec (clinicaltrials.gov) - P2 | N=45 | Recruiting | Sponsor: Candel Therapeutics, Inc. | Trial completion date: Aug 2026 ➔ Feb 2027 | Trial primary completion date: Aug 2026 ➔ Feb 2027

Biomarker • Trial completion date • Trial primary completion date • Genito-urinary Cancer • Oncology • Prostate Adenocarcinoma • Prostate Cancer • Solid Tumor