Raoul T wrote on Health Rising asked me:
Hi Ken, Maybe I was over reacting but i was intrigued to learn about the feature “Big Antiviral Trial Could Usher in New Treatment Era for FM” on Health Rising a couple of weeks ago discussing the promising use of Celebrex with Valtrex as a new and effective strategy for FM and CFS. I just wondered what you opinion on this might be. Are there significant heath risks associated with Celebrex? If so are there any good alternatives? Has anyone you know tried or had success using this therapy?This is a difficult question to answer well in comments, so I am answering in a post. I am also declaring that I am evaluating it against my current model of CFS is: a stable dysfunction of microbiota.
Celebrex is a nonsteroidal anti-inflammatory drug (NSAID – i.e. acteaminophen like) and selective COX-2 inhibitor. Valacycloviris an antiviral drug effective against several members of the Herpes family (which is associated with some CFS sub-populations).
To test against the model, I grab my microflora grid:
| Antibiotic Family | Klebsiella/Enterobacter | Enterococcus | Streptococcus | E.Coli | Bifidobacterium | Lactobacillus |
|---|---|---|---|---|---|---|
| In CFS Patients | HIGH | HIGH | HIGH | low | low | low |
| Celebrex | N/I | INCREASE | N/I | INCREASE | REDUCES (?) | N/I |
| Valacyvlovir | N/I | N/I | N/I | N/I | N/I | N/I |
| Herpes Virus: |
- N/I – No Information
- (?) Study is not clear (drug combination involved so uncertainity
On the other side, the presence of the virus does impact the microbiota [2013],[2008], [2013]
For CFS, there are three studies on Valacyclovir – all done by a team lead by AM Lerner:
- Antibody to Epstein-Barr virus deoxyuridine triphosphate nucleotidohydrolase and deoxyribonucleotide polymerase in a chronic fatigue syndrome subset. [2012]
” identified an Epstein-Barr virus (EBV) subset of patients (6),” (about 15% of those meeting the formal definition)…”Patients with Group A CFS with subsets CMV or HHV6 do not respond to valacyclovir” - Valacyclovir treatment in Epstein-Barr virus subset chronic fatigue syndrome: thirty-six months follow-up.[2007]
- A six-month trial of valacyclovir in the Epstein-Barr virus subset of chronic fatigue syndrome: improvement in left ventricular function.[2002]
” Valacyclovir is not an effective anti-human cytomegalovirus antiviral drug. Unimproved CFS patients with co-infections EBV and human cytomegalovirus may require combined treatment with valacyclovir and another drug more active against human cytomegalovirus”
And one with Fibromyalgia – “No effect of antiviral (valacyclovir) treatment in fibromyalgia: a double blind, randomized study.”[2004] “Valacyclovir cannot be recommended as a therapy for FM at this point.” and none for IBS.
Bottom Line
This treatment appears effective for a minority subset of those matching a research definition of CFS (and likely an even smaller number of the general CFS population). Appropriate testing should occur before the start and if the results of the testing does not match that of the subset, it is best not to proceed with this treatment. I am opposed to “well, it’s not an exact match — but let us try it anyway” approach of some MDs.