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Evidence summaries

Pre-Emptive Antiviral Treatment to Prevent Cytomegalovirus Disease in Solid Organ Transplant Recipients

Pre-emptive treatment with antiviral agents for solid organ transplant recipients reduces the risk of cytomegalovirus disease when compared to placebo or standard care. The outcomes are similar to routine prophylactic antiviral therapy. There is insufficient evidence of the efficacy of pre-emptive therapy compared with prophylaxis to prevent CMV disease. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 15 studies on pre-emptive treatment, i.e. treatment only when there is evidence of CMV infection during routine screening, with a total of 1098 subjects. Compared with placebo or standard care, pre-emptive treatment significantly reduced the risk of CMV disease (six trials, 288 patients: RR 0.29, 95% CI 0.11 to 0.80) but not acute rejection (three trials, 185 patient: RR 1.06, 95% CI 0.64 to 1.76) or all-cause mortality (3 trials, 176 patients: RR 1.23, 95% CI 0.35 to 4.30). Comparative trials of pre-emptive therapy versus prophylaxis showed no significant difference in the risks of CMV disease (7 studies, 753 participants: RR 1.00, 95% CI 0.36 to 2.74; I² = 63%, 7 trials, n=753). Leucopenia was significantly less common with pre-emptive therapy compared with prophylaxis ( RR 0.42, 95% CI 0.20 to 0.90; 6 studies, n=729). There were no significant differences in the risks of acute rejection, all-cause mortality, or graft loss.

References

  • Owers DS, Webster AC, Strippoli GF et al. Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev 2013;(2):CD005133. [PubMed]

Primary/Secondary Keywords