Systematic review of ganciclovir pharmacodynamics during the prevention of cytomegalovirus infection in adult solid organ transplant recipients
| Autor: | Diana D. Wong, Maria E. Craig, William D. Rawlinson, Wendy J. van Zuylen |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Human cytomegalovirus Ganciclovir Adult Male medicine.medical_specialty Adolescent viruses 030106 microbiology Congenital cytomegalovirus infection Antiviral Agents Chemoprevention 03 medical and health sciences Immunocompromised Host Young Adult Virology Internal medicine medicine Humans Prospective Studies Viremia Prospective cohort study Aged Retrospective Studies Base Composition business.industry Incidence (epidemiology) Incidence Valganciclovir Organ Transplantation Middle Aged medicine.disease Transplant Recipients 030104 developmental biology Infectious Diseases Treatment Outcome Pharmacodynamics Cytomegalovirus Infections Female business medicine.drug Cohort study |
| Zdroj: | Reviews in medical virology. 29(2) |
| ISSN: | 1099-1654 |
| Popis: | Human cytomegalovirus (CMV) represents the most common infection among recipients of solid organ transplants (SOTs). Previous meta-analysis showed 0.8% of SOT recipients developed CMV disease whilst receiving valganciclovir (ValGCV) prophylaxis. However, the clinical utility of monitoring ganciclovir (GCV) blood concentrations is unclear. We systematically reviewed the association between GCV concentrations during prophylaxis and the incidence of CMV. MEDLINE and EMBASE databases were searched for studies between 1946 and 2018, where GCV pharmacokinetics and incidence of CMV viraemia or disease in SOT were available. Research designs included randomised trials, comparative, prospective cohort, retrospective, or case report studies. Only human adult studies were included, with English language restriction. The 11 studies that met the eligibility criteria included 610 participants receiving GCV or ValGCV prophylaxis. Quality assessment showed 2/4 randomised trials, 4/6 cohort studies, and 1/1 case report were of high quality. Despite dose adjustments for renal impairment, mean GCV exposures for patients were heterogeneous and ranged between 28 and 53.7 μg·h/mL across three randomised trials. The incidence of CMV infection and disease ranged from 0% to 50% and 0% to 3.1%, respectively, with follow up between 3 to 9 months. One study showed statistical power in determining relationship, where GCV exposure at 40 to 50 μg·h/mL in high-risk SOT recipients was associated with a reduced risk of viraemia. Clinical monitoring for GCV exposure can be applied to high-risk SOT recipients during ValGCV prophylaxis; however, further studies are needed to determine the utility of monitoring in all SOT recipients. |
| Databáze: | OpenAIRE |
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