Valganciclovir Results in Improved Oral Absorption of Ganciclovir in Liver Transplant Recipients

Pescovitz, Mark D.; Rabkin, John M.; Merion, Robert M.; Payá, Carlos V.; Pirsch, John D.; Freeman, Richard B.; O’Grady, John; Robinson, Charles Alexander; To, Zung; Wren, Kristina; Banken, Ludger; Buhles, William; Brown, Frances C.

doi:10.1128/aac.44.10.2811-2815.2000

Cited by 327 publications

(252 citation statements)

References 25 publications

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“…Valganciclovir, a valine ester of ganciclovir, provides sys temic ganciclovir levels that are comparable to IV ganci clovir [73,76] . Pharmacokinetic studies indicate that a 900 mg dose of valganciclovir achieves a similar daily area under the concentration time curve (AUC24) as an IV dose of 5 mg/kg of ganciclovir [73] .…”

Section: Valganciclovir Prophylaxismentioning

confidence: 99%

Current concepts on cytomegalovirus infection after liver transplantation

Lee

Razonable

2010

WJH

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Cytomegalovirus (CMV) is the most common viral pathogen that negatively impacts on the outcome of liver transplantation. CMV cause febrile illness often accompanied by bone marrow suppression, and in some cases, invades tissues including the transplanted allograft. In addition, CMV has been significantly asso ciated with an increased predisposition to allograft rejection, accelerated hepatitis C recurrence, and other opportunistic infections, as well as reduced overall pa tient and allograft survival. To negate the adverse effects of CMV on outcome, its prevention, whether through antiviral prophylaxis or preemptive therapy, is regarded as an essential component to the medical management of liver transplant patients. Two recent guidelines have suggested that antiviral prophylaxis or preemptive therapy are similarly effective in preventing CMV disease in modest-risk CMV-seropositive liver trans plant recipients, while antiviral prophylaxis is the preferred strategy over preemptive therapy for the preven tion of CMV disease in high-risk recipients [CMV-seronegative recipients of liver allografts from CMV-seropositive donors (D+/R-)]. However, antiviral prophylaxis has only delayed the onset of CMV disease in many CMV D+/R-liver transplant recipients, and at least in one study, such occurrence of late-onset primary CMV disease was significantly associated with increased mortality after liver transplantation. Therefore, optimized strategies for prevention are needed, and aggressive treatment of CMV infection and disease should be pursued. The standard treatment of CMV disease consists of intravenous ganciclovir or oral valganciclovir, and if feasible, one should also reduce the degree of immunosuppression. In one recent controlled clinical trial, val ganciclovir was found to be as effective and safe as intravenous ganciclovir for the treatment of mild to mo derate CMV disease in solid organ (including liver) tran splant recipients. In this article, the authors review the current state and the future perspectives of prevention and treatment of CMV disease after liver transplantation.

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Section: Valganciclovir Prophylaxismentioning

confidence: 99%

Current concepts on cytomegalovirus infection after liver transplantation

Lee

Razonable

2010

WJH

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“…Valganciclovir, a valine ester of ganciclovir, which results in enhanced absorption, resulting in systemic drug levels that are comparable to IV ganciclovir [68,71] . Pharmacokinetic studies indicate that a 900 mg dose of valganciclovir achieves a similar daily area under the concentration time curve (AUC 24 ) as an IV dose of 5 mg/kg of ganciclovir [68] .…”

Section: Valganciclovir Prophylaxismentioning

confidence: 99%

Cytomegalovirus infection after liver transplantation: Current concepts and challenges

Razonable

2008

WJG

181

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“…Previous pharmacokinetic studies showed similar drug exposure to ganciclovir after a single oral dose of 900 mg valganciclovir as compared to an intravenous dose of 5 mg/kg ganciclovir. [9][10][11] Recently, oral valganciclovir and intravenous ganciclovir were shown to have similar efficacy in pre-emptive CMV treatment in solid organ transplant recipients. [12][13][14] As a consequence, the prevention of CMV disease in high-risk renal, renal-pancreas and heart transplant patients was added as another indication to the original approval of valganciclovir for the treatment of CMV retinitis in AIDS patients.…”

Section: Introductionmentioning

confidence: 99%

Oral valganciclovir as pre-emptive therapy has similar efficacy on cytomegalovirus DNA load reduction as intravenous ganciclovir in allogeneic stem cell transplantation recipients

Heiden

Kalpoe

Barge

et al. 2006

Bone Marrow Transplant

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The efficacy and safety of oral valganciclovir was compared to ganciclovir i.v. in pre-emptive treatment of cytomegalovirus (CMV) in T-cell-depleted allogeneic stem cell transplant (allo-SCT) recipients. A therapeutic guideline was developed to allow the safe application of valganciclovir in allo-SCT recipients requiring CMV therapy. In total, 107 consecutive transplant recipients were evaluated. Cytomegalovirus DNA load in plasma was monitored longitudinally; details on antiviral therapy and treatment responses were analyzed retrospectively. Fifty-seven CMV treatment episodes were recorded in 34 patients: 20 with valganciclovir (900 mg twice-daily) and 37 with ganciclovir (5 mg/kg twice-daily). Median CMV DNA load reduction was 0.079 and 0.069 log 10 copies/ml/ day in the ganciclovir and valganciclovir group, respectively. Good response on CMV DNA load (reduction below 3.0 log 10 copies/ml) was observed in 75.7% of ganciclovir and 80.0% of valganciclovir treatment episodes. Severe adverse effects were not observed and CMV-related disease did not occur. However, the percentage of patients receiving erythrocyte transfusion was higher in the group of patients receiving ganciclovir as compared to valganciclovir (41 versus 20%, P ¼ 0.116). In conclusion, pre-emptive treatment with valganciclovir and ganciclovir, led to similar reduction of CMV DNA load. Oral valganciclovir is an attractive and safe alternative for pre-emptive CMV treatment in T-cell-depleted allo-SCT recipients.

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Valganciclovir Results in Improved Oral Absorption of Ganciclovir in Liver Transplant Recipients

Abstract: The pharmacokinetics of an orally administered valine ester of ganciclovir (GCV), valganciclovir (VGC), were studied. These were compared to the pharmacokinetics of oral and intravenous GCV.

Cited by 327 publications

References 25 publications

Current concepts on cytomegalovirus infection after liver transplantation

Current concepts on cytomegalovirus infection after liver transplantation

Cytomegalovirus infection after liver transplantation: Current concepts and challenges

Oral valganciclovir as pre-emptive therapy has similar efficacy on cytomegalovirus DNA load reduction as intravenous ganciclovir in allogeneic stem cell transplantation recipients

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