Trial reportBMC neurology2008
Protocol for German trial of Acyclovir and corticosteroids in Herpes-simplex-virus-encephalitis (GACHE): a multicenter, multinational, randomized, double-blind, placebo-controlled German, Austrian and Dutch trial [ISRCTN45122933].
Trial report in BMC neurology, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
35 citing papers in PubMed, 3 syntheses or guidelines pooled it, 101 citations in OpenAlex.
- Diagnosis and Management of Infectious Encephalitis in Adults: Guidelines From the European Academy of Neurology and European Society of Clinical Microbiology and Infectious Diseases.European journal of neurology · 2026Guideline
- Steroids for the treatment of viral encephalitis: a systematic literature review and meta-analysis.Journal of neurology · 2023Pooled it
- Intravenous immunoglobulin for the treatment of childhood encephalitis.The Cochrane database of systematic reviews · 2017Pooled it
- Herpes Simplex Encephalitis: Lack of Clinical Benefit of Long-term Valacyclovir Therapy.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2015Trial
- Infectious meningitis and encephalitis: A primer for acute care practitioners.Journal of the Intensive Care Society · 2026Review
- The cell-mediated adaptive immune response to herpes simplex virus type 1 encephalitis: mechanisms and clinical implications.Frontiers in immunology · 2026Review
- Severe Usutu Virus Encephalitis Treated With Corticosteroids: A Case Report.Case reports in infectious diseases · 2026Article
- Are Glucocorticoids Truly Effective in Improving the Clinical Prognosis of HSV-1 Encephalitis?Infection and drug resistance · 2025Article
- Clinical use of steroids in viral central nervous system (CNS) infections: three challenging cases.Journal of neurovirology · 2021Article
- Protocol for DexEnceph: a randomised controlled trial of dexamethasone therapy in adults with herpes simplex virus encephalitis.BMJ open · 2021Article
- Herpes simplex virus type 1 related acute retinal necrosis following an encephalitis illness: a case report.BMC neurology · 2021Article
- The Use of Adjunctive Steroids in Central Nervous Infections.Frontiers in cellular and infection microbiology · 2020Review
- Severe presentation of antibody-negative, postinfectious steroid-responsive encephalitis and atonic bladder after herpes simplex encephalitis.BMJ case reports · 2019Article
- Diagnosis and Management of Acute Encephalitis in Children.Indian journal of pediatrics · 2019Review
- The German trial on Aciclovir and Corticosteroids in Herpes-simplex-virus-Encephalitis (GACHE): a multicenter, randomized, double-blind, placebo-controlled trial.Neurological research and practice · 2019Article
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- [Intensive care studies from 2016/2017].Der Anaesthesist · 2017Article
- Infectious encephalitis: Management without etiological diagnosis 48hours after onset.Medecine et maladies infectieuses · 2017Review
- Herpes Simplex Encephalitis: an Update.Current infectious disease reports · 2017Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 8 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe treatment of Herpes-simplex-virus-encephalitis (HSVE) remains a major unsolved problem in Neurology. Current gold standard for therapy is acyclovir, a drug that inhibits viral replication. Despite antiviral treatment, mortality remains up to 15%, less than 20% of patients are able to go back to work, and the majority of patients suffer from severe disability. This is a discouraging, unsatisfactory situation for treating physicians, the disabled patients and their families, and constitutes an enormous burden to the public health services. The information obtained from experimental animal research and from recent retrospective clinical observations, indicates that a substantial benefit in outcome can be expected in patients with HSVE who are treated with adjuvant dexamethasone. But currently there is no available evidence to support the routine use of adjuvant corticosteroid treatment in HSVE. A randomized multicenter trial is the only useful instrument to address this question.
designGACHE is a multicenter, randomized, double-blind, placebo-controlled, parallel group clinical trial of treatment with acyclovir and adjuvant dexamethasone, as compared with acyclovir and placebo in adults with HSVE. The statistical design will be that of a 3-stage-group sequential trial with potential sample size adaptation in the last stage.
conclusion372 patients with proven HSVE (positive HSV-DNA-PCR), aged 18 up to 85 years; with focal neurological signs no longer than 5 days prior to admission, and who give informed consent will be recruited from Departments of Neurology of academic medical centers in Germany, Austria and The Netherlands. Sample size will potentially be extended after the second interim analysis up to a maximum of 450 patients.
trial registrationCurrent Controlled TrialsISRCTN45122933.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.