Adverse Effect of Cytosine Arabinoside on Disseminated Zoster in a Controlled Trial

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Abstract
Cytosine arabinoside for the treatment of disseminated herpes zoster was evaluated in a randomized, double-blind controlled study. The drug was given within 48 hours of onset of dissemination at 100 mg per square meter per 24 hours by continuous intravenous infusion, until dissemination ceased, or for a maximum of 72 hours. The treatment (19 patients) and placebo (20 patients) groups were of similar composition so far as underlying disease, previous treatment and stage of dissemination at the time of study were concerned. The duration of dissemination was greater in the treated than in the placebo group, and was prolonged for a subgroup of cytosine-arabinoside-treated patients with Stage III and IV lymphoma. The lymphoma patients also had evidence of depression of antibody formation, delay in vesicle interferon appearance, depression of local cellular response and greater hematologic toxicity. Cytosine arabinoside at this dose thus has no beneficial effect on the disease, and can prolong it in some compromised patients by further depressing host responses. (N Engl J Med 289:873–878, 1973)