Abstract
Cytomegalovirus (CMV) infection is one of the most common complications after solid organ transplantation. Clinically, there have been several kinds of antiviral drugs for the prevention and treatment of CMV, such as acyclovir, valacyclovir, ganciclovir and valganciclovir. In order to evaluate the efficacy and safety of these antiviral drugs, we performed a Bayesian network meta-analysis. We searched relevant prospective and multi-armed studies on PubMed up to Mar.2018. The primary outcome is the occurrence of CMV infection and CMV disease after solid organ transplantation. Finally, 17 prospective studies involving 2062 patients were included in our analysis. In the case of CMV infection, the ganciclovir group (OR= 0.24 95% CI: 0.09-0.57) and the valacyclovir group (OR=0.20 95% CI: 0.04-0.69) is significantly better than the control group. The ganciclovir (OR=0.37 95% CI: 0.13-0.86) and valacyclovir groups (OR=0.31 95% CI: 0.07-0.98) showed moderate superiority compared to the acyclovir group. As for CMV disease, the ganciclovir group, the valacyclovir group and the valganciclovir group showed significant advantages compared with the control group (ganciclovir group: OR=0.17 95% CI: 0.07-0.31, valacyclovir group: OR=0.08 95% CI: 0.01-0.33, valganciclovir group: OR=0.14 95% CI: 0.02-0.45). Similarly, the ganciclovir group (OR=0.38 95% CI: 0.12-0.71) and the valacyclovir group (OR=0.17 95% CI: 0.03-0.72) is better than the acyclovir group. In our conclusion, valacyclovir might be the most efficient in the prevention and treatment of CMV infection and disease. However, it is also likely to induce leukopenia. Acyclovir may have the weakest therapeutic effect, while the possibility of leukopenia is also minimal. In order to achieve better effect, doctors should consider the clinical situation of every patient before clinical selection of antiviral drugs. Funding: None. Declaration of Interest: We declare no competing interests.
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