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Comparative Efficacy and Safety of Different Antiviral Agents for Cytomegalovirus Prophylaxis in Allogeneic Hematopoietic Cell Transplantation: A Systematic Review and Meta-Analysis
- Source :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 24(10)
- Publication Year :
- 2018
-
Abstract
- Over the past 25 years, several randomized controlled trials have investigated the efficacy of different antiviral agents for cytomegalovirus (CMV) prophylaxis in allogeneic hematopoietic cell transplantation. We performed a systematic literature review, conventional meta-analysis, and network meta-analysis using a random-effects model and risk ratios (RRs) with corresponding 95% confidence intervals (CIs) as effect estimates. Fifteen randomized controlled trials were identified, including 7 different antiviral agents: acyclovir, ganciclovir, maribavir, brincidofovir, letermovir, valacyclovir, and vaccine. Twelve trials used placebo as comparator while 3 trials compared different antiviral agents. We found evidence for CMV disease and infection being significantly reduced by antiviral prophylaxis, with an RR of .66 (95% CI, .48 to .90) and .63 (95% CI, .50 to .79). Across the network, ganciclovir showed the best relative efficacy for CMV disease while letermovir provided first rank of being the best option for CMV infection. The risk for death was not significantly influenced by antiviral prophylaxis in the meta-analysis, with an RR of .92 (95% CI, .78 to 1.08), as well as in the network meta-analysis. In terms of safety, letermovir was at least similar in comparison with placebo and most agents while both letermovir and acyclovir showed significantly reduced risk for serious adverse events compared with ganciclovir, with RRs of .55 (95% CI, .30 to 1.00) for letermovir and .63 (95% CI, .42 to .93) for acyclovir. With a probability of 81%, letermovir appears to be the best option in terms of safety. Future randomized head-to-head comparisons are needed to evaluate the definite efficacy and safety of different prophylactic strategies.
- Subjects :
- Ganciclovir
Male
medicine.medical_specialty
Acyclovir
Cytomegalovirus
Brincidofovir
Acetates
Placebo
Antiviral Agents
law.invention
03 medical and health sciences
Letermovir
0302 clinical medicine
Randomized controlled trial
law
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
Adverse effect
Transplantation
business.industry
Hematopoietic Stem Cell Transplantation
virus diseases
Maribavir
Hematology
Allografts
030220 oncology & carcinogenesis
Valacyclovir
Cytomegalovirus Infections
Quinazolines
Benzimidazoles
Female
Ribonucleosides
business
medicine.drug
Subjects
Details
- ISSN :
- 15236536
- Volume :
- 24
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Accession number :
- edsair.doi.dedup.....3b40ea85d84171dee21f62ba06805a4d