REPLY
Preemptive Ganciclovir Therapy in Renal Transplantation
Patricia L. Hibberd, MD, PhD, and
Robert H. Rubin, MD
1 April 1996 | Volume 124 Issue 7 | Pages 693-694
IN RESPONSE:
We are delighted that Brennan and colleagues express interest in our study [1]. Generally, prophylaxis refers to preventive therapy that is widely used in a population but is not specifically directed to patients at highest risk for disease. In our study, we deliberately focused on a limited patient population at risk for developing CMV disease and chose the term "preemptive therapy" to clearly distinguish this approach from prophylaxis. We believe that the concept underlying the preemptive approach is more important than the term itself but remain interested in hearing about better terms to describe the preemptive approach. Clinical characteristics should be as acceptable as results of laboratory tests to define a "high-risk" patient population that might benefit from the "preemptive approach" [2].
We were also pleased to hear from Dr. Tamm and colleagues. They describe a similar preemptive approach to prevention of CMV disease that was effective in their patient population. On completion of our study, we recognized that the optimal dosing of ganciclovir still needs to be established. At the Massachusetts General Hospital, we have doubled the daily dose of ganciclovir administered to our high-risk patients (5 mg/kg daily if serum creatinine levels are less than 3 mg/dL). This increased dose is both effective and well tolerated. Thus, we conclude that the validity of preemptive therapy has been established, although the optimal regimen may require further adjustment.
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Author and Article Information
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Massachusetts General Hospital; Boston, MA 02114
1. Hibberd PL, Tolkoff-Rubin NE, Conti D, Stuart F, Thistlethwaite JR, Neylan JF, et al. Preemptive ganciclovir therapy to prevent cytomegalovirus disease in cytomegalovirus antibody-positive renal transplant recipients. A randomized controlled trial. Ann Intern Med. 1995; 123:18-26.
2. Rubin RH. Preemptive therapy in immunocompromised hosts. N Engl J Med. 1991; 324:1057-9.
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