Published: Fri, January 20, 2017
World | By Tasha Manning

Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients - Hodson - 2013 - The Cochrane Library - Wiley Online Library

Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients - Hodson - 2013 - The Cochrane Library - Wiley Online Library

Antiviral drugs for the prevention of cytomegalovirus in patients receiving solid organ transplants

Search methods

P> We searched MEDLINE, EMBASE and the Cochrane Central Registry of Controlled Trials (CENTRAL) in the Cochrane Library until February 2004 for the first version of this review. We searched the Cochrane Renal Group specialized registry until February 2007, and until July 2011 for the first and second update of the review. We excluded randomized controlled trials (RCTs) and quasi-randomized trials comparing antiviral drugs versus placebo or no treatment.

Selection criteria

, Comparing different antiviral medications and comparing different regimens of the same antiviral drugs in patients receiving any solid organ transplant. We excluded studies that evaluated other preventive therapies.

Data collection and analysis

Two reviewers independently assessed study eligibility, risk of bias and extracted The data. The results were presented as relative risk (RR) or risk differences (RD) with a 95% confidence interval (95% CI) for dichotomous outcomes and the mean difference (MD) with 95% CI for continuous outcomes. We performed the statistical analyzes using the random effects model. We performed subgroup analysis and univariate meta-regression using restricted likelihood to estimate the variance between studies. We performed a multivariate meta-regression to investigate whether the results were altered after considering the differences of drugs used, transplanted organ and the presence of anti-CMV antibodies (serological status) of the recipient at the time of transplantation.

Main results

Prophylaxis with acyclovir, ganciclovir or valaciclovir compared to placebo or no treatment significantly reduced the risk of CMV infection (19 studies; RR 0.42, 95% CI 0.34-0.52), CMV infection (17 studies, RR 0.61, 95% CI 0.48-0.77), all-cause mortality (17 studies, RR 0.63, 95% CI 0.43-0.92), mainly due to the Reduction in mortality by cytomegalovirus (7 studies, RR 0.26, 95% CI 0.08-0.78). Prophylaxis reduced the risk of herpes simplex and herpes zoster, bacterial and protozoal infections, but not fungal infection, acute rejection or graft loss.

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Meta-regression did not show a significant difference in relative benefit Of treatment (risk of cytomegalovirus or all-cause mortality) by transplanted organ or serological status; No conclusion was possible for CMV negative patients who received negative organs.

Neurological dysfunction was more common in patients receiving ganciclovir and valaciclovir compared to placebo / no treatment. In the direct comparison studies, ganciclovir was more effective than aciclovir in preventing cytomegalovirus (7 studies, RR 0.37, 95% CI 0.23-0.60), and leukopenia was more common with aciclovir. Valganciclovir and ganciclovir IV were as effective as oral ganciclovir. According to three small studies, the efficacy and adverse effects of valganciclovir / ganciclovir did not differ from valaciclovir. Long-term prophylaxis significantly reduced the risk of cytomegalovirus in comparison with three months of prophylaxis (2 studies; RR 0.20, 95% CI 0.12-0.35). Leukopenia was more common with long-term prophylaxis, but the serious adverse effects associated with treatment did not differ between long-term and three-month treatments.

Authors' conclusions

Translation notes

Translation of the Cochrane Center of Brazil (Michele Palmeira da Silva).

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