1. Use of Viral Load as a Surrogate Marker in Clinical Studies of Cytomegalovirus in Solid Organ Transplantation: A Systematic Review and Meta-analysis
- Author
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Gary Fahle, Robin K. Avery, Debra Birnkrant, Jeffrey C. Murray, Yoshihiko Murata, Mary Singer, Randi Y. Leavitt, Hans H. Hirsch, Lynn Fallon, Francisco Martinez-Murillo, John E. McKinnon, Gavin Cloherty, Randall Lanier, Rekha Abichandani, Philip R. Krause, Sally Mossman, M Michelle Berrey, Wael Saber, Ali Alghamdi, John A. D. Leake, Raymund R. Razonable, Takashi E. Komatsu, Emily A. Blumberg, Mahmood Tazari, Kurt Gunter, Thomas Mertens, Jens D Lundgren, Yoichiro Natori, Sunwen Chou, Kevin Modarress, Jay Erdman, Li Li, Terry Bowlin, Peter W. Hunt, William Cruikshank, Anna Wijatyk, Frank Kuhr, Garrett Nichols, Aimee Hodowanec, Marcie L. Riches, Shahid Husain, Karl S. Peggs, Jules O'Rear, Johann Mols, Filip Josephson, Christopher Lademacher, Paul Baum, Bernhardt Zeiher, Paul D. Griffiths, Susan Barnett, Mark N. Prichard, Michael Boeckh, Roy F. Chemaly, Megan McCutcheon, Thomas Stamminger, Fausto Baldanti, Chalom Sayada, Veronica Miller, Andreas Pikis, Atul Humar, Dimitri Gonzalez, Barbara D. Alexander, Jennifer Brooks, Jeff Roberts, Camille N. Kotton, Hermann Einsele, Tadd Lazarus, David Boutolleau, Deepali Kumar, Sandra Nusinoff Lehrman, Ani Orchanian-Cheff, Howard Mayer, Heather Gillis, Dong Yu, David Murawski, Per Ljungman, Paula Isabelle Lodding, and Lesia K. Dropulic
- Subjects
Microbiology (medical) ,Ganciclovir ,medicine.medical_specialty ,Cytomegalovirus ,Viremia ,Disease ,030230 surgery ,Antiviral Agents ,Gastroenterology ,Organ transplantation ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Randomized Controlled Trials as Topic ,business.industry ,Surrogate endpoint ,Incidence ,Incidence (epidemiology) ,virus diseases ,Organ Transplantation ,Odds ratio ,Viral Load ,medicine.disease ,Transplant Recipients ,Infectious Diseases ,Cytomegalovirus Infections ,DNA, Viral ,030211 gastroenterology & hepatology ,business ,Viral load ,Biomarkers ,medicine.drug - Abstract
Symptomatic cytomegalovirus (CMV) disease has been the standard endpoint for clinical trials in organ transplant recipients. Viral load may be a more relevant endpoint due to low frequency of disease. We performed a meta-analysis and systematic review of the literature. We found several lines of evidence to support the validity of viral load as an appropriate surrogate end-point, including the following: (1) viral loads in CMV disease are significantly greater than in asymptomatic viremia (odds ratio, 9.3 95% confidence interval, 4.6-19.3); (2) kinetics of viral replication are strongly associated with progression to disease; (3) pooled incidence of CMV viremia and disease is significantly lower during prophylaxis compared with the full patient follow-up period (viremia incidence: 3.2% vs 34.3%; P < .001) (disease incidence: 1.1% vs 13.0%; P < .001); (4) treatment of viremia prevented disease; and (5) viral load decline correlated with symptom resolution. Based on the analysis, we conclude that CMV load is an appropriate surrogate endpoint for CMV trials in organ transplant recipients.
- Published
- 2017
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