Clinical

Ganciclovir plus foscarnet offers no advantage against CMV

Last Updated: 2004-05-04 12:28:33 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In transplant recipients with cytomegalovirus viremia, the combination of ganciclovir and foscarnet in reduced doses is not more effective than ganciclovir alone in preventing cytomegalovirus disease.

In the April 15th issue of The Journal of Infectious Diseases, a multicenter British team led by Dr. Frank M. Mattes, of the Royal Free and University College Medical School in London, describes a study in which 48 transplant recipients with cytomegalovirus viremia were randomized to receive either full-dose ganciclovir (5 mg/kg intravenously twice daily) or half-dose ganciclovir (5 mg only once daily) plus half-dose foscarnet (90 mg/kg intravenously once daily).

Treatments were given for 14 days. The primary endpoint of the study was clearance of cytomegalovirus DNA within the treatment period, as documented by polymerase chain reaction.

"In the ganciclovir arm, 17 (71%) of 24 patients reached the primary endpoint...compared with 12 (50%) of 24 patients in the ganciclovir-plus-foscarnet arm," the authors report.

They point out that these outcomes were not significantly different, although "there was a trend in favor of the ganciclovir arm." Furthermore, toxicity was greater with the combination regimen.

"This trial has shown that, at the doses used, combination antiviral therapy with ganciclovir plus foscarnet for cytomegalovirus viremia does not appear to control viral replication better than does ganciclovir monotherapy," the researchers conclude.

J Infect Dis 2004;189:1355-1361