Valacyclovir prophylaxis versus preemptive valganciclovir therapy to prevent cytomegalovirus disease after renal transplantation
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu srovnávací studie, časopisecké články, randomizované kontrolované studie, práce podpořená grantem
PubMed
17973956
DOI
10.1111/j.1600-6143.2007.02031.x
PII: S1600-6135(22)05664-7
Knihovny.cz E-zdroje
- MeSH
- acyklovir analogy a deriváty ekonomika terapeutické užití MeSH
- antivirové látky ekonomika terapeutické užití MeSH
- cytomegalovirové infekce ekonomika epidemiologie prevence a kontrola MeSH
- Cytomegalovirus * MeSH
- dospělí MeSH
- ganciklovir analogy a deriváty ekonomika terapeutické užití MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- transplantace ledvin * škodlivé účinky ekonomika MeSH
- valaciclovir MeSH
- valganciklovir MeSH
- valin analogy a deriváty ekonomika terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
- Názvy látek
- acyklovir MeSH
- antivirové látky MeSH
- ganciklovir MeSH
- valaciclovir MeSH
- valganciklovir MeSH
- valin MeSH
Both preemptive therapy and universal prophylaxis are used to prevent cytomegalovirus (CMV) disease after transplantation. Randomized trials comparing both strategies are sparse. Renal transplant recipients at risk for CMV (D+/R-, D+/R+, D-/R+) were randomized to 3-month prophylaxis with valacyclovir (2 g q.i.d., n = 34) or preemptive therapy with valganciclovir (900 mg b.i.d. for a minimum of 14 days, n = 36) for significant CMV DNAemia (>/=2000 copies/mL by quantitative PCR in whole blood) assessed weekly for 16 weeks and at 5, 6, 9 and 12 months. The 12-month incidence of CMV DNAemia was higher in the preemptive group (92% vs. 59%, p < 0.001) while the incidence of CMV disease was not different (6% vs. 9%, p = 0.567). The onset of CMV DNAemia was delayed in the valacyclovir group (37 +/- 22 vs. 187 +/- 110 days, p < 0.001). Significantly higher rate of biopsy-proven acute rejection during 12 months was observed in the preemptive group (36% vs. 15%, p = 0.034). The average CMV-associated costs per patient were $5525 and $2629 in preemptive therapy and valacyclovir, respectively (p < 0.001). However, assuming the cost of $60 per PCR test, there was no difference in overall costs. In conclusion, preemptive valganciclovir therapy and valacyclovir prophylaxis are equally effective in the prevention of CMV disease after renal transplantation.
Department of Internal Medicine 1 Charles Medical School and Teaching Hospital Pilsen Czech Republic
Citace poskytuje Crossref.org
