Effectiveness of Valganciclovir 900 mg versus 450 mg for Cytomegalovirus Prophylaxis in Transplantation: Direct and Indirect Treatment Comparison Meta-analysis

Kalil, André C.; Mindru, Cezarina; Florescu, Diana F.

doi:10.1093/cid/ciq143

Cited by 65 publications

(49 citation statements)

References 33 publications

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“…When used for prophylaxis, the usual dose of VGC is 900 mg a day, versus treatment dose which is 900 mg twice daily (both should be adjusted for renal function). Recently, several new studies directly comparing VGC 900 mg with VGC 450 mg daily in RTR have been published (11)(12)(13)(14)(15)(16)(17), and a meta-analysis compared two regimens only be carried in sold organ transplantation (18). Therefore, it is important and necessary to directly assess the benefits and the risks between VGC 450 mg and VGC 900 mg in RTR in order to produce an evidence-based recommendation for clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Valganciclovir 900mg Versus 450mg for Cytomegalovirus Prophylaxis in Renal Transplantation: A Systematic Review and Meta-Analysis

et al. 2017

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-Objectives:Valganciclovir 900 mg/day is approved for cytomegalovirus (CMV) prophylaxis, but 450 mg/day is seems also effective. We systematically reviewed the efficacy and safety of low-dose versus high-dose valganciclovir prophylaxis in renal transplantation recipients. Methods: An electronic search was conducted up to November 29, 2016. The primary outcomes were incidences of CMV, CMV disease, mortality and opportunistic infection. The second outcomes were acute rejection, allograft loss, adverse drug reaction (ADR). Results: 7 cohort studies, all with high quality involving (1431 patients) were included. There was no significant difference of the incidence of following CMV disease (1271 10, p=0.14) between the low-dose and the high-dose valganciclovir prophylaxis. And no significant difference was observed for premature valganciclovir discontinuation (1010 patients, OR 0.81, 95%CI 0.52-1.25, p=0.33) and the incidence of leukopenia (1082 patients, OR 0.65, 95%CI 0.34-1.22, p=0.18) between the two regimens. Conclusion: 450 mg and 900 mg doses of valganciclovir are equipotent for CMV universal prophylaxis. CMV 450 mg prophylaxis should be used for renal transplant recipients.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of Valganciclovir 900mg Versus 450mg for Cytomegalovirus Prophylaxis in Renal Transplantation: A Systematic Review and Meta-Analysis

et al. 2017

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“…1,6,7,19,20,23 Despite high incidence of thymoglobulin use in our cohort, the incidence of CMV disease was low (5%) without significant differences between the groups. This could be related to less incidence of HLA-A, HLA-B, and HLA-DR mismatches in our patients, the regular screening program applied to them, and the use of universal valganciclovir prophylaxis (Table 1).…”

Section: Cytomegalovirus Diseasementioning

confidence: 71%

“…22 In a multivariate analysis, 12 trials with 900 mg valganciclovir (1543 patients) and 8 trials with 450 mg valganciclovir (1531 patients) were included. 23 In the high-risk group (D+/R−), 900 mg valganciclovir showed equivalent efficacy to 450 mg valganciclovir (statistical power: 97%) for CMV universal prophylaxis. 23 A dose of 900 mg valganciclovir was significantly associated with a 3-time increase in the risk of leukopenia and 2-time increase in the risk of rejection compared with 450 mg valganciclovir.…”

Section: Introductionmentioning

confidence: 92%

“…23 In the high-risk group (D+/R−), 900 mg valganciclovir showed equivalent efficacy to 450 mg valganciclovir (statistical power: 97%) for CMV universal prophylaxis. 23 A dose of 900 mg valganciclovir was significantly associated with a 3-time increase in the risk of leukopenia and 2-time increase in the risk of rejection compared with 450 mg valganciclovir. 23 It is recommended to administer valganciclovir prophylaxis for 200 days after transplant, which is proven to be more efficacious than a 100-day course in preventing CMV disease in high-risk patients.…”

Section: Introductionmentioning

confidence: 92%

“…23 A dose of 900 mg valganciclovir was significantly associated with a 3-time increase in the risk of leukopenia and 2-time increase in the risk of rejection compared with 450 mg valganciclovir. 23 It is recommended to administer valganciclovir prophylaxis for 200 days after transplant, which is proven to be more efficacious than a 100-day course in preventing CMV disease in high-risk patients. 19,20 We hypothesized that low-dose valganciclovir, at 450 mg/d for 6 months, may have the same prophylactic effect against CMV disease in intermediaterisk kidney transplant recipients, with a better safety profile and patient compliance.…”

Section: Introductionmentioning

confidence: 94%

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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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Effectiveness of Valganciclovir 900 mg versus 450 mg for Cytomegalovirus Prophylaxis in Transplantation: Direct and Indirect Treatment Comparison Meta-analysis

Cited by 65 publications

References 33 publications

Effectiveness of Valganciclovir 900mg Versus 450mg for Cytomegalovirus Prophylaxis in Renal Transplantation: A Systematic Review and Meta-Analysis

Effectiveness of Valganciclovir 900mg Versus 450mg for Cytomegalovirus Prophylaxis in Renal Transplantation: A Systematic Review and Meta-Analysis

Untitled

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

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