Valacyclovir (valA) is effective and more tolerable than valganciclovir (valG) for cytomegalovirus (CMV) prophylaxis in kidney transplant recipients, according to new data presented at the 2022 American Transplant Congress (ATC 2022) in Boston, Massachusetts.
In a trial, investigators randomly assigned 66 kidney transplant recipients (KTRs) to valA and 71 to valG for CMV prophylaxis after surgery. Of the cohort, 30% were pediatric and 70% adult patients. Drug dose was based on age and estimated glomerular filtration rate (eGFR). Duration of antiviral therapy was 3 months for seronegative donor-recipient pairs or 6 months for adults and 12 months for children when the donor or recipient or both were seropositive.
CMV viremia and disease incidence, time to CMV viremia, and CMV viral load time were comparable between groups, Priya Verghese, MB BS, MPH, of the Ann & Robert H Lurie Children’s Hospital and Northwestern University Feinberg School of Medicine in Chicago, Illinois reported on behalf of her team.
Drug discontinuation or dose reduction due to side effects — the study’s primary end point — occurred in a significantly lower proportion of valA than valG users: 2% vs 21%. The most common reason for valG dose reduction was leukopenia. Leukopenia required granulocyte colony-stimulating factor (such as Filgrastim) in a significantly higher proportion of the valG (25%) than valA (5%) group.
Viral infections are a significant cause of post-transplant morbidity and mortality. Dr Verghese concluded that valA is more tolerable than valG in preventing CMV infection after kidney transplantation in both adults and children with significantly less dose-limiting side effects.
In an interview, Dr Verghese said her team found no differences in transplant outcomes between the valA and valG group. She noted, however, that a previous study demonstrated an increased incidence of rejection among valacyclovir users.
Verghese PS, Matas A, Chinnakotla S, Evans M, Jr HBalfour. Post-kidney transplant valacyclovir versus valganciclovir for CMV prophylaxis: a randomized controlled trial [abstract]. Am J Transplant. 2022;22 (suppl 3). Presented at: ATC 2022; June 4-8; Boston, Massachusetts. Abstract 51.