title: Lessons Learned From a Randomized Study of Oral Valganciclovir Versus Parenteral Ganciclovir Treatment of Cytomegalovirus Disease in Solid Organ Transplant Recipients: The VICTOR Trial.
abstract: The VICTOR study showed comparable efficacy of treatment with intravenous ganciclovir and oral valganciclovir for cytomegalovirus (CMV) disease in solid organ transplant recipients. Oral therapy is now recommended treatment in clinical practice and guidelines. The VICTOR biobank was used in a series of post hoc analyses that yielded unique and clinically valuable insights into CMV treatment and pathogenesis. For example, the importance of tailoring therapy to initial viral load, the effect of immunosuppression on outcomes, and the need to continue therapy until undetectable viral load to prevent recurrence and emergence of resistant strains. Data were also used to validate the use of international units (IU) in quantitative measurements of CMV DNAemia, which may help future studies to define relevant cutoffs for treatment guidance. The analyses also showed the importance of inflammation on viral outcomes and identified potential targets for future studies. Here we summarize the valuable lessons learned from analysis of the VICTOR data set and sample repository.
authors.affiliation: Department of Transplant Medicine, Section of Nephrology Department of Pharmaceutical Biosciences, School of Pharmacy.
authors.forename: Anders
authors.initials: A
authors.lastname: Åsberg
authors.affiliation: Department of Medicine and Multi-organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.affiliation: Department of Microbiology Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Rollag
authors.affiliation: Department of Medicine, University of Glasgow, United Kingdom.
authors.forename: Alan G
authors.initials: AG
authors.lastname: Jardine
authors.affiliation: Department of Medicine and Multi-organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
authors.forename: Deepali
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Norway Research Institute of Internal Medicine Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet.
authors.forename: Pål
authors.initials: P
authors.lastname: Aukrust
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Norway Research Institute of Internal Medicine.
authors.forename: Thor
authors.initials: T
authors.lastname: Ueland
authors.affiliation: School of Specialization in Hospital Pharmacy, University of Milan, Italy.
authors.forename: Angelo A
authors.initials: AA
authors.lastname: Bignamini
authors.affiliation: Department of Transplant Medicine, Section of Nephrology Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: Anders
authors.initials: A
authors.lastname: Hartmann
mesh_terms: D000284:Administration, Oral; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000187:drug effects; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation; D007263:Infusions, Parenteral; D016378:Tissue Transplantation / Q000009:adverse effects*; D066027:Transplant Recipients; D016896:Treatment Outcome; D000077562:Valganciclovir; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: CMV disease; cytomegalovirus; ganciclovir; treatment; valganciclovir