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ArticleJMIR research protocols2025

Optimization of Preemptive Therapy for Cytomegalovirus Infections With Valganciclovir Based on Therapeutic Drug Monitoring: Protocol for a Phase II, Single-Center, Single-Arm Trial.

Naoki Tamura, Kotaro Itohara, Yo Ueda, Yumi Kitahiro, Kazuhiro Yamamoto, Tomohiro Omura, Toshiyasu Sakane, Jun Saegusa, Ikuko Yano

Abstract readClinical Trial Protocol
In one paragraph

Article in JMIR research protocols, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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0 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Naoki TamuraDepartment of Pharmacy, Kobe University Hospital, Kobe, Japan.ORCID 0009-0004-2664-9411
Kotaro ItoharaDepartment of Pharmacy, Kobe University Hospital, Kobe, Japan.ORCID 0000-0002-7982-7881
Yo UedaDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.ORCID 0000-0001-6065-8486
Yumi KitahiroDepartment of Pharmacy, Kobe University Hospital, Kobe, Japan.ORCID 0000-0002-0263-5726
Kazuhiro YamamotoDepartment of Pharmacy, Kobe University Hospital, Kobe, Japan.ORCID 0000-0002-7513-6725
Tomohiro OmuraDepartment of Pharmacy, Kobe University Hospital, Kobe, Japan.ORCID 0000-0001-5520-253X
Toshiyasu SakaneDepartment of Pharmaceutical Technology, Kobe Pharmaceutical University, Kobe, Japan.ORCID 0000-0002-6504-0623
Jun SaegusaDepartment of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.ORCID 0000-0001-7606-3743
Ikuko YanoDepartment of Pharmacy, Kobe University Hospital, Kobe, Japan.ORCID 0000-0001-9517-5628

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundValganciclovir (VGCV) is the first-line drug for preemptive therapy of cytomegalovirus (CMV) infections. However, even when administered at the dose specified in the package insert, there is significant interindividual variability in the plasma concentrations of ganciclovir (GCV). In addition, correlations have been reported between the area under the concentration-time curve and therapeutic efficacy or adverse events. Therefore, therapeutic drug monitoring (TDM) can be used to improve the efficacy and safety of preemptive VGCV therapy.

objectiveThis study aims to evaluate whether the dosage adjustment of VGCV based on TDM in patients undergoing preemptive therapy for CMV infections is associated with the successful completion rate of treatment without severe hematological adverse effects.

methodsThis phase II, single-center, single-arm trial aims to enroll 40 patients admitted at the Department of Rheumatology and Clinical Immunology, Kobe University Hospital, who will receive oral VGCV as preemptive therapy for CMV infections. Participants will begin treatment with VGCV at the dose recommended in the package insert, with subsequent dose adjustments based on weekly TDM results. The primary end point will be the proportion of patients who achieve CMV antigenemia negativity within 3 weeks without severe hematological adverse events. The secondary end points will include weekly changes in CMV antigen levels, total VGCV dose, and duration of preemptive therapy. For safety evaluation, the occurrence, type, and severity of VGCV-related adverse events will be analyzed. Additionally, this study will explore the correlations between the efficacy and safety of preemptive therapy and the pharmacokinetic parameters of GCV, CMV-polymerase chain reaction values, and nudix hydrolase 15 (NUDT15) genetic polymorphisms. The correlation between GCV plasma concentrations obtained from regular venous blood and blood concentrations will be examined using dried blood spots.

resultsThis study began with patient recruitment in September 2024, with 5 participants enrolled as of June 16, 2025. The target enrollment is 40 participants, and the anticipated study completion is set for July 2027.

conclusionsThis is the first study to investigate the impact of TDM intervention in patients receiving VGCV as preemptive therapy. The findings are postulated to provide valuable evidence regarding the utility of TDM in patients receiving VGCV as preemptive therapy.

trial registrationJapan Registry of Clinical Trials jRCTs051240080; https://jrct.mhlw.go.jp/latest-detail/jRCTs051240080. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/72549.

Indexed as

Antiviral AgentsCytomegalovirus InfectionsDrug MonitoringValganciclovirAdultClinical Trials, Phase II as TopicCytomegalovirusFemaleGanciclovirHumansMaleMiddle AgedAntiviral AgentsGanciclovirValganciclovircytomegalovirusdried blood spotsganciclovirpreemptive therapytherapeutic drug monitoringvalganciclovir

Identifiers

PMID40553505
PMCPMC12238781

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.