title: Cytomegalovirus incidence between everolimus versus mycophenolate in de novo renal transplants: pooled analysis of three clinical trials.
abstract: Everolimus (EVR) in heart and renal transplant (RTx) recipients may be associated with a decreased incidence of cytomegalovirus (CMV). A detailed analysis of the association between EVR versus mycophenolic acid (MPA) and CMV events has not been reported. CMV data from 2004 de novo RTx recipients from three-randomized, prospective, EVR studies A2309 (N = 833), B201 (N = 588) and B251 (N = 583) were retrospectively analyzed to identify differences between two EVR dosing groups and MPA. EVR groups received 1.5 mg/day, or 3 mg/day with either standard (SD-CsA) or reduced dose cyclosporine (RD-CsA). Controls received MPA with SD-CsA. CMV prophylaxis was as per center practice. CMV incidence (infection/syndrome, disease, viremia) was captured per local center evaluations. Kaplan-Meier analyses demonstrated that freedom from CMV viremia and infection/syndrome was significantly greater for EVR versus MPA for recipients without CMV prophylaxis. Among recipients who received prophylaxis, freedom from viremia was greater for EVR 3.0 mg; freedom from infection/syndrome was greater for EVR 3.0 and 1.5 mg. Although freedom from organ involvement was numerically greater for EVR, it was not statistically significant. This analysis documents significant reductions in the incidence of CMV infection/syndrome and viremia in EVR-treated de novo RTx recipients, especially those who did not receive CMV prophylaxis versus MPA.
authors.affiliation: Washington University School of Medicine Barnes-Jewish Hospital, St. Louis, MO, USA. brennan@wudosis.wustl.edu
authors.forename: D C
authors.initials: DC
authors.lastname: Brennan
authors.forename: C
authors.initials: C
authors.lastname: Legendre
authors.forename: D
authors.initials: D
authors.lastname: Patel
authors.forename: K
authors.initials: K
authors.lastname: Mange
authors.forename: A
authors.initials: A
authors.lastname: Wiland
authors.forename: K
authors.initials: K
authors.lastname: McCague
authors.forename: F S
authors.initials: FS
authors.lastname: Shihab
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000187:drug effects; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D000068338:Everolimus; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014766:Viremia / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000068338:Everolimus; D009173:Mycophenolic Acid; D015774:Ganciclovir; D020123:Sirolimus