Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients

Hodson, Elisabeth M; Ladhani, Maleeka; Webster, Angela C; Strippoli, Giovanni F.M.; Craig, Jonathan C.

doi:10.1002/14651858.cd003774.pub4

Cited by 121 publications

(78 citation statements)

References 138 publications

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“…Acyclovir and valacyclovir are also used to prevent CMV, although both have significantly reduced anti-CMV activity and are not recommended as first-line agents in recent guidelines (1-4), but are effectively used to prevent other human herpesvirus infections, including varicella, and as such have an important role in antiviral prophylaxis for CMV D−/R− SOT recipients. In early work on CMV prevention, acyclovir was determined to be inferior to oral ganciclovir (30), although at lower doses than others have used. Meta-analysis of direct comparison studies demonstrated that ganciclovir was more effective than acyclovir in preventing CMV disease (7 studies; RR 0.37, 95% CI 0.23-0.60) (31).…”

Section: Antiviral Medications For Universal Prophylaxis and Preemptimentioning

confidence: 99%

CMV: Prevention, Diagnosis and Therapy

Kotton

2013

American Journal of Transplantation

243

218

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Cytomegalovirus (CMV) is the most common infection after organ transplantation and has a major impact on morbidity, mortality and graft survival. Optimal prevention, diagnosis and treatment of active CMV infection enhance transplant outcomes, and are the focus of this section. Methods to prevent CMV include universal prophylaxis and preemptive therapy; each has its merits, and will be compared and contrasted. Diagnostics have improved substantially in recent years, both in type and quality, allowing for more accurate and savvy treatment; advances in diagnostics include the development of an international standard, which should allow comparison of results across different methodologies, and assays for cellular immune function against CMV. Therapy primarily involves ganciclovir, now rendered more versatile by data suggesting oral therapy with valganciclovir is not inferior to intravenous therapy with ganciclovir. Treatment of resistant virus remains problematic, but is enhanced by the availability of multiple novel therapeutic agents.

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Section: Antiviral Medications For Universal Prophylaxis and Preemptimentioning

confidence: 99%

CMV: Prevention, Diagnosis and Therapy

Kotton

2013

American Journal of Transplantation

243

218

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“…31 Most of our kidney transplant recipients and their donors were seropositive, which is comparable with other studies. 10,12,31 Immunosuppression, leukopenia attacks, and rejection episodes Intensive immunosuppression is one of the main precipitating factors for CMV disease. 5,6 Half of our patients received thymoglobulin (Table 1), which has a severe bone marrow suppressive effect.…”

Section: Demographic Featuresmentioning

confidence: 99%

“…1 At our center, most kidney transplant recipients are at moderate risk for CMV infection and they receive universal prophylaxis due to its ease of administration, effectiveness, and prophylaxis against other viruses and possibly other bacterial and protozoan infections. [6][7][8][9][10][11][12] Valganciclovir is a valine ester prodrug of ganciclovir that was developed to overcome the limitations of oral and intravenous ganciclovir. [10][11][12] A single daily 900-mg oral dose provides comparable plasma ganciclovir exposures to those achieved with 5 mg/kg intravenous ganciclovir.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12] Valganciclovir is a valine ester prodrug of ganciclovir that was developed to overcome the limitations of oral and intravenous ganciclovir. [10][11][12] A single daily 900-mg oral dose provides comparable plasma ganciclovir exposures to those achieved with 5 mg/kg intravenous ganciclovir. [10][11][12][13][14][15][16][17][18] Valganciclovir has significant adverse effects, including diarrhea, fever, and leukopenia.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] A single daily 900-mg oral dose provides comparable plasma ganciclovir exposures to those achieved with 5 mg/kg intravenous ganciclovir. [10][11][12][13][14][15][16][17][18] Valganciclovir has significant adverse effects, including diarrhea, fever, and leukopenia. 19,20 It is crucial to directly measure estimated glomerular filtration rate (eGFR) and adjust valganciclovir dose accordingly.…”

Section: Introductionmentioning

confidence: 99%

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Halim

Al-Otaibi²,

Gheith³

et al. 2016

Exp Clin Transplant

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Objectives: Prophylaxis for cytomegalovirus infection is highly recommended for kidney transplant recipients. The use of daily 900 mg valganciclovir is the usual prophylactic dose, whereas 450 mg daily is under investigation. We evaluated the outcome of using 2 different doses of valganciclovir prophylaxis for cytomegalovirus infection after kidney transplant. Materials and Methods: We randomized kidney transplant recipients (1:1) to receive 450 mg daily valganciclovir (group 1) or 900 mg daily valganciclovir (group 2) for the first 6 months after kidney transplant. Serologically, all patients were at moderate risk for cytomegalovirus infection. Patients were studied for incidence of cytomegalovirus disease, leukopenia attacks, rejection episodes, and graft outcomes for 1 year. Results: Demographic features of group 1 (98 patients) and group 2 (98 patients) were comparable. More than 50% of patients received thymoglobulin induction therapy without difference between the groups. There were more leukopenia attacks in group 2 (P = .03) requiring higher doses of granulocyte colonystimulating factor (P = .03). Group 2 patients received lower doses of mycophenolate mofetil (P= .04) and required reduced doses of valganciclovir (P = .045). Compared with group 1, the high-dose group developed numerically more rejection episodes (P = .057) and more cytomegalovirus infections requiring full treatment (P = .17). Graft and patient outcomes were satisfactory in both groups. Conclusion:Six months of low-dose valganciclovir prophylaxis for intermediate-risk kidney transplant recipients was as effective as high-dose valganciclovir with a better safety profile.

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Safety and Efficacy of Antiviral Therapy for Prevention of Cytomegalovirus Reactivation in Immunocompetent Critically Ill Patients

et al. 2017

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Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients

Abstract: Prophylaxis with antiviral medications reduces CMV disease and CMV-associated mortality in solid organ transplant recipients. These data suggest that antiviral prophylaxis should be used routinely in CMV positive recipients and in CMV negative recipients of CMV positive organ transplants.

Cited by 121 publications

References 138 publications

CMV: Prevention, Diagnosis and Therapy

CMV: Prevention, Diagnosis and Therapy

Untitled

Safety and Efficacy of Antiviral Therapy for Prevention of Cytomegalovirus Reactivation in Immunocompetent Critically Ill Patients

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