Overview

DexEnceph: A study of dexamethasone in adults with Herpes Simplex Virus (HSV) encephalitis

HSV Hotline: 0300 008 0007        E-Mail:  dexenceph@liverpool.ac.uk

Summary Results for Participants

Why I have been sent a link to the DexEnceph summary results?

You have been sent a link to these summary results because the DexEnceph study has now finished, and we wanted to let you know what we found out during the study. We also wanted to thank you again for taking part in this study; the results of this study could lead to a positive change to how patients like you are being treated. The information we have collected is very important and tells us a lot. We could not have done this without your help and participation.

What was the purpose of the study?

The purpose of the study was to look at how effective the use of dexamethasone in combination with standard treatment of acyclovir is in improving the recovery of patients with (Herpes Simplex Virus) HSV encephalitis.

Why was I invited?

You were asked to participate because you were diagnosed with HSV encephalitis. A total of 94 participants aged 16 years and older with HSV encephalitis throughout the UK participated in the study.

Which drug/ drugs were being tested?

The study involved the use of dexamethasone given together with acyclovir compared to standard treatment of acyclovir alone.

Dexamethasone is used widely in patients and the side-effects are well known as this medicine has been prescribed for a long time. A short course of dexamethasone was prescribed in this study. Dexamethasone is a type of medicine called a steroid and treats health conditions such as severe allergies, skin conditions, sickness and swelling in the eye. It was also recently used as a treatment for severe COVID-19 and other serious infections.

Acyclovir was introduced in the 1980s and significantly reduced the mortality from HSV encephalitis. Despite treatment, some people are left with significant loss of memory. About 2 out of every 3 people will have memory difficulties long term.

What happens to me now the study has stopped?

After you finished taking part in the study, your doctor will have explained what happens next. Your doctor will have treated you according to normal clinical practice.

Are there any side effects that we should report now the study has ended?

During the study we closely monitored any side effects that may have been experienced by you. Now that the study has finished your doctor has been asked to report any side effects, they feel that may have been related to dexamethasone. If you are concerned at any time, please contact the doctor or nurse who looked after you during the study.

Will my taking part in the study be kept confidential?

Yes. We will follow ethical and legal practice and all information which is collected about you during the research will be kept strictly confidential. All data collected during the study will be kept for a maximum of 15 years after the study has ended, during this time all your information will be kept confidential.

What were the results of the study and how will they be made available?

In the DexEnceph study we looked at each participant after 26 weeks from taking part to see if there had been an improvement in verbal memory.

Between Sept 22, 2016, and Feb 2, 2022, 94 participants with HSV encephalitis were recruited, 47 to the treatment group (dexamethasone plus acyclovir), and 47 to the control group (acyclovir alone).

The results of the study showed that there was not a big difference in verbal memory scores between the treatment and the control group. However, the results suggest that participants starting dexamethasone treatment sooner had better verbal memory scores than those starting the treatment later; so, it may be beneficial if given early.

Dexamethasone treatment in HSV encephalitis is not harmful, the results showed that it was safe and well tolerated. Participants taking dexamethasone plus acyclovir did not show any major differences in side effects compared with participants taking acyclovir alone.

This is the first ever completed study of dexamethasone in HSV encephalitis in the world, with 94 participants from 39 UK hospitals taking part.

Have the results of the study been seen by anyone else?

Some of the results were shown at the encephalitis international conference in December 2024. This conference was attended by encephalitis experts from around the world.

Will I be given any results about me as an individual?

We will not publish any individual results, if you would like to know more about your results during the study please speak to your study nurse or doctor.

Invitation to take part in patient involvement

When research studies like this one are being set up, we like to get input from patients into the design of the study and what impact the study may have on patients. We also like to have patient involvement throughout the study.

Examples of patient involvement include:
- help make sure researchers ask the right questions
- help make sure the research design is appropriate
- help make sure information about the research is easy to understand
- help make sure reported results are clear and easy to understand

If this is something you might be interested in doing, please visit the following websites which provide general information about patient and public involvement in research including how you can get involved:

The National Institute for Health Research website

INVOLVE

The Liverpool Clinical Trials Centre, University of Liverpool is keen to ensure patients, and the public could be actively involved in research.

Contact details

Please contact your doctor or nurse on the telephone number you were given when you joined the study if you have any queries.

Thank you

We want to thank you again for taking part in this study. The results of this study could make a positive change to how other patients like you are being treated. We could not have done this groundbreaking study without the help and participation of the patients and families that took part in the study.

  • This is a study for patients with encephalitis (swelling of the brain) caused by a virus called herpes simplex virus (HSV).
  • Encephalitis can make you confused, drowsy, behave out of character, affect your sleep and memory, change your mood, cause you to have fits and often leaves patients with memory problems.
  • We want to find out if reducing the swelling with a drug called dexamethasone is of benefit to patient’s memory in the longer term.
  • Dexamethasone is a commonly used drug in brain swelling and many other conditions
  • In the study there will be two groups of patients, one that receives dexamethasone for 4 days and one that does not.
  • Both groups will have the same investigations to see if dexamethasone has been of benefit.
  • The study is being run through Brain Infections UK from the Institute of Infection and Global Health in collaboration with the Encephalitis society and Walton Centre.

Randomised patients

7

Target patients

90

Open sites

44

Target Sites

90

Collaborators

The University of Liverpool    The Clinical Trials Research Center    The UK Clinical Virology Network    The University of Manchester    The Encephalitis Society    The Walton Centre

Study funder

This study has been funded by the National Institute for Health Research's Efficacy and Mechanism Evaluation (EME) Programme (ref: 12/205/28)..

Study Sponsor

The University Of Liverpool.

Study review and approval

The study has been reviewed by a research ethics committee, who have agreed the study is being conducted in a correct and appropriate manner. The study has also been approved by the Medicines & Healthcare products Regulatory Agency (MHRA).

Trial Summary and Frequently Asked Questions

HSV encephalitis ?

Encephalitis means swelling of the brain and has many different causes. It is often caused by a virus. Herpes Simplex Virus (HSV) is the most common virus that causes encephalitis in the UK.

HSV encephalitis is very rare. It is diagnosed by finding the virus in fluid around the brain and spinal cord. This fluid is called CSF (cerebrospinal fluid). The CSF is obtained by the doctor who performs a lumbar puncture (LP).

HSV encephalitis is treated with the drug aciclovir. Despite treatment, some people are left with significant loss of memory. About 2 out of every 3 people will have memory difficulties long term.

Why are we doing this study?

We know dexamethasone can reduce swelling. Reduction in swelling of the brain may improve the recovery of patients with HSV encephalitis.

This study, called DexEnceph, will allow us to compare the recovery of patients that received dexamethasone and those that did not.

Why me?

There are two reasons why you may have been invited to take part:

  • Your doctors have diagnosed you with having HSV encephalitis.
or
  • You may have been invited to take part before the diagnosis is made. This is because your doctors think there is a chance you may have HSV encephalitis. This will mean you have more time to think about taking part.

Do I have to say yes?

No not at all. It’s completely up to you. We only want you to take part if you want to. Just tell us if you don’t.

If you decide not to, don’t worry, it won’t change how you are looked after.

If you decide to take part, you will be given this leaflet to keep. You will be asked if you would like to sign a form to say that you understand what will happen and that you are happy to take part. Your parent/carer(s) will also have to sign a form to say they are happy for you to take part.

If you decide to take part that would be really helpful. If you then change your mind, that’s OK as well - you can, and don’t have to say why if you don’t want to.

What will happen to me during the study?

All patients in the study will receive aciclovir. This is standard treatment for HSV encephalitis.

In addition, if you decide to take part in the study, you may be offered a short course of dexamethasone. This will be decided at random by a computer. This is to be fair, so neither you, your doctor, nor the research team, can choose whether you receive dexamethasone or not. Half of the people in the study will receive dexamethasone and half will not.

If you receive dexamethasone this will be 4 times a day for 4 days. It is given in a line you already have for clinical care.

Recruiting Centres

  • Queen Elizabeth Hospital Birmingham B15 2TH
  • Heartlands Hospital B9 5SS
  • Bradford Royal Infirmary BD9 6RJ
  • Royal Bolton Hospital BL4 0JR
  • Cumberland Infirmary CA2 7HY
  • West Cumberland Hospital CA28 8JG
  • Addenbrooke's Hospital CB2 0QQ
  • The Countess of Chester Hospital CH2 1UL
  • University Hospital Coventry & Warwickshire CV2 2DX
  • The Royal London Hospital E1 1BB
  • Western General Hospital EH4 2XU
  • The Royal Devon and Exeter NHS Foundation Trust EX2 5DW
  • Blackpool Victoria Hospital FY3 8NR
  • Northwick Park Hospital HA1 3UJ
  • Huddersfield Royal Infirmary HD3 3EA
  • Calderdale Royal Hospital HX3 0PW
  • St. Peter's Hospital KT16 0PZ
  • The Royal Liverpool University Hospital L7 8XP
  • The Walton Centre L9 7LJ
  • Leicester Royal Infirmary LE1 5WW
  • Lincoln County Hospital LN2 5QY
  • St. James's University Hospital LS9 7TF
  • Wythenshawe Hospital M23 9LT
  • Salford Royal M6 8HD
  • Royal Victoria Infirmmary NE1 4LP
  • Northumbria Specialist Emergency Care Hospital NE23 6NZ
  • Norfolk and Norwich University Hospitals NHS Foundation Trust NR4 7UY
  • John Radcliffe Hospital OX3 9DU
  • Derriford Hospital PL6 8DH
  • Queen Alexandra Hospital PO6 3LY
  • Royal Preston Hospital PR2 9HT
  • Barking, Havering and Redbridge University Hospitals NHS Trust RM7 0AG
  • Royal Hallamshire Hospital S10 2JF
  • King's College Hospital SE5 9RS
  • Southend Hospital SS0 0RY
  • Royal Stoke University Hospital ST4 6QG
  • Musgrove Park Hospital TA1 5DA
  • Royal Cornwall Hospital TR1 3LQ
  • University Hospital Of North Tees TS19 8PE
  • James Cook University Hospital TS4 3BW
  • Ealing Hospital UB1 3HW
  • Hammersmith Hospital W12 0HS
  • Charing Cross Hospital W6 8RF

Contacts

Please feel free to contact the DexEnceph study team by any of the means below:

Telephone


0151 794 9767

HSV Hotline: 030 0008 0007

Address

Medicines for Children Clinical Trials Unit
University of Liverpool
Institute of Child Health
Alder Hey Children's NHS Foundation Trust
Liverpool
L12 2AP