Valganciclovir versus valacyclovir prophylaxis for prevention of cytomegalovirus: an economic perspective

Kacer, Martin; Kielberger, Lukáš; Bouda, Mirko; Reischig, Tomáš

doi:10.1111/tid.12383

Cited by 14 publications

(12 citation statements)

References 32 publications

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“…Advantages of valacyclovir include less myelotoxicity and lower cost. 210,213,215 New Drugs for CMV Prevention New potent oral drugs would be useful additions to the currently available therapies for CMV prevention. Three compounds are in various stages of late development.…”

Section: Optimal Duration Of Prophylaxismentioning

confidence: 99%

The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation

et al. 2018

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Despite recent advances, cytomegalovirus (CMV) infections remain one of the most common complications affecting solid organ transplant recipients, conveying higher risks of complications, graft loss, morbidity, and mortality. Research in the field and development of prior consensus guidelines supported by The Transplantation Society has allowed a more standardized approach to CMV management. An international multidisciplinary panel of experts was convened to expand and revise evidence and expert opinion-based consensus guidelines on CMV management including prevention, treatment, diagnostics, immunology, drug resistance, and pediatric issues. Highlights include advances in molecular and immunologic diagnostics, improved understanding of diagnostic thresholds, optimized methods of prevention, advances in the use of novel antiviral therapies and certain immunosuppressive agents, and more savvy approaches to treatment resistant/refractory disease. The following report summarizes the updated recommendations.

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Section: Optimal Duration Of Prophylaxismentioning

confidence: 99%

The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation

et al. 2018

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“…Nevertheless, owing to its increased oral bioavailability, valacyclovir has superseded acyclovir for the treatment of HSV or VZV infections (254). In a recent study, an economic comparison between valacyclovir and valganciclovir was performed, suggesting that in the first year after renal transplantation, valganciclovir was more cost-effective than valacyclovir (255). On the other hand, famciclovir offers significant benefits, such as cost-effective therapy and accelerated rates of lesion resolution (256).…”

Section: Acyclic Guanosine Analoguesmentioning

confidence: 99%

Approved Antiviral Drugs over the Past 50 Years

2016

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SUMMARYSince the first antiviral drug, idoxuridine, was approved in 1963, 90 antiviral drugs categorized into 13 functional groups have been formally approved for the treatment of the following 9 human infectious diseases: (i) HIV infections (protease inhibitors, integrase inhibitors, entry inhibitors, nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, and acyclic nucleoside phosphonate analogues), (ii) hepatitis B virus (HBV) infections (lamivudine, interferons, nucleoside analogues, and acyclic nucleoside phosphonate analogues), (iii) hepatitis C virus (HCV) infections (ribavirin, interferons, NS3/4A protease inhibitors, NS5A inhibitors, and NS5B polymerase inhibitors), (iv) herpesvirus infections (5-substituted 2′-deoxyuridine analogues, entry inhibitors, nucleoside analogues, pyrophosphate analogues, and acyclic guanosine analogues), (v) influenza virus infections (ribavirin, matrix 2 protein inhibitors, RNA polymerase inhibitors, and neuraminidase inhibitors), (vi) human cytomegalovirus infections (acyclic guanosine analogues, acyclic nucleoside phosphonate analogues, pyrophosphate analogues, and oligonucleotides), (vii) varicella-zoster virus infections (acyclic guanosine analogues, nucleoside analogues, 5-substituted 2′-deoxyuridine analogues, and antibodies), (viii) respiratory syncytial virus infections (ribavirin and antibodies), and (ix) external anogenital warts caused by human papillomavirus infections (imiquimod, sinecatechins, and podofilox). Here, we present for the first time a comprehensive overview of antiviral drugs approved over the past 50 years, shedding light on the development of effective antiviral treatments against current and emerging infectious diseases worldwide.

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“…This result was important in our center, because the use of valacyclovir was not only considered for its clinical advantages, which have been reported in several studies, 14,33 but more importantly, for its low cost. 34 Our observation suggests that valacyclovir may be used as the first line of prophylactic treatment for patients who do not have an opportunity to be treated with valganciclovir or oral ganciclovir in low-and middle-income countries.…”

Section: Discussionmentioning

confidence: 85%

Characteristics and Outcomes of Cytomegalovirus Infection in Seropositive Kidney Transplant Recipients in the Era of Antiviral Prophylaxis with Valacyclovir: A Single-Center Study in Morocco

Rezzouk¹,

Bouattar²,

Belkadi³

et al. 2021

TRRM

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Purpose: Despite the use of antiviral prophylaxis with valacyclovir, cytomegalovirus infection (CMV) can still occur in seropositive kidney transplant recipients. In this study, we aimed to assess the incidence of CMV DNAemia and its risk factors in Moroccan transplant recipients. Patients and Methods: Sixty kidney recipients with positive cytomegalovirus serostatus, receiving post-transplant prophylaxis were enrolled between 2013 and 2017. In total, 455 plasma samples were collected and tested for CMV DNAemia using PCR-based Abbott RealTime assays. Results: The incidence of CMV infection in seropositive patients was 63%. In patients with quantifiable DNAemia, the duration of CMV infection was significantly shorter than in those with detectable DNAemia (141.5 ± 96.9 vs 294.1 ± 112.6 days, P < 0.001). During prophylactic treatment, 14 of 30 patients (47.0%) experienced active replication with quantifiable DNAemia, whereas none of eight patients with detectable DNAemia did (P = 0.017). Patients with symptomatic DNAemia were significantly younger than those without symptoms (28.8 ± 5.12 vs 38.1 ± 12.34 years, P = 0.007). The peak viral loads were significantly associated with viral disease (odds ratio: 3.39, 95% confidence interval: 1.21-9.53, P = 0.02). The duration of DNAemia (21.2 vs 13.4 days, P = 0.028) was significantly longer in symptomatic patients. Significantly higher rates of acute rejection were exclusively observed in recipients with disease (4/8, 50% vs 0/22, 0%, P = 0.003). Conclusion:Patients with high-level DNAemia were at an increased risk of progression to disease and acute rejection. Monitoring the viral load during the first year posttransplantation is essential, to support current preventive strategies.

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Valganciclovir versus valacyclovir prophylaxis for prevention of cytomegalovirus: an economic perspective

Abstract: VACV prophylaxis for CMV is associated with a significant 44% lower cost than vGCV at the first year after renal transplantation.

Cited by 14 publications

References 32 publications

The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation

The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid-organ Transplantation

Approved Antiviral Drugs over the Past 50 Years

Characteristics and Outcomes of Cytomegalovirus Infection in Seropositive Kidney Transplant Recipients in the Era of Antiviral Prophylaxis with Valacyclovir: A Single-Center Study in Morocco

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