Valacyclovir prophylaxis versus preemptive valganciclovir therapy to prevent cytomegalovirus disease after renal transplantation
Language English Country United States Media print-electronic
Document type Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
PubMed
17973956
DOI
10.1111/j.1600-6143.2007.02031.x
PII: S1600-6135(22)05664-7
Knihovny.cz E-resources
- MeSH
- Acyclovir analogs & derivatives economics therapeutic use MeSH
- Antiviral Agents economics therapeutic use MeSH
- Cytomegalovirus Infections economics epidemiology prevention & control MeSH
- Cytomegalovirus * MeSH
- Adult MeSH
- Ganciclovir analogs & derivatives economics therapeutic use MeSH
- Incidence MeSH
- Middle Aged MeSH
- Humans MeSH
- Prospective Studies MeSH
- Aged MeSH
- Kidney Transplantation * adverse effects economics MeSH
- Valacyclovir MeSH
- Valganciclovir MeSH
- Valine analogs & derivatives economics therapeutic use MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
- Geographicals
- Czech Republic epidemiology MeSH
- Names of Substances
- Acyclovir MeSH
- Antiviral Agents MeSH
- Ganciclovir MeSH
- Valacyclovir MeSH
- Valganciclovir MeSH
- Valine 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
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