Systematic Review: Prophylactic antivirals significantly reduce CMV disease and mortality in organ transplant recipients – Cochrane Library
6 May, 2024 | 06:18h | UTCStudy Design and Population:
This systematic review and randomized controlled trial assessed the benefits and harms of antiviral medications in preventing cytomegalovirus (CMV) disease among solid organ transplant recipients. The analysis included 41 studies with a total of 5,054 participants. The reviewed studies compared various antiviral drugs, such as aciclovir, ganciclovir, and valaciclovir, against placebos or no treatment, and examined different dosing regimens.
Main Findings:
The findings revealed that prophylaxis with aciclovir, ganciclovir, or valaciclovir significantly reduces the risk of developing CMV disease, with risk ratios (RRs) indicating strong effectiveness (RR 0.42, 95% CI 0.34-0.52 for CMV disease prevention). The treatments also lowered all-cause mortality (RR 0.63, 95% CI 0.43-0.92) and CMV infection rates (RR 0.61, 95% CI 0.48-0.77). Additionally, ganciclovir was found to be more effective than aciclovir in preventing CMV disease (RR 0.37, 95% CI 0.23-0.60). The extended duration of prophylaxis appeared to offer additional benefits compared to shorter courses.
Implications for Practice:
The results support the routine use of antiviral prophylaxis in both CMV-positive recipients and CMV-negative recipients receiving organs from CMV-positive donors. These findings are crucial for clinical practice, indicating that maintaining or implementing antiviral prophylaxis can significantly decrease the incidence of CMV disease and related mortality in this high-risk population. Further studies are recommended to explore optimal dosing and duration strategies, especially among different organ transplant groups and varying immunosuppressive regimes.
Reference (link to abstract – $ for full-text):