Valganciclovir Treatment of Cytomegalovirus Disease: A Promising But Not Yet Fully Validated Therapeutic Approach

The data presented by Fellay et al. (1) represent important information that supports the possible use of valganciclovir as an alternative to the ‘gold standard’ of intravenous (i.v.) ganciclovir therapy for cytomegalovirus (CMV) disease treatment in solid organ transplant (SOT) recipients, a substitution that is theoretically possible based on pharmacokinetic data (2). However, despite these promising results, high-quality evidence that valganciclovir is equivalent to i.v. ganciclovir with respect to efficacy and safety in this setting is lacking. Hopefully, this issue will be resolved when the results of an international multi-center randomized controlled trial, currently in progress, comparing valganciclovir to i.v. ganciclovir for CMV disease treatment are available. In the interim, it is premature to recommend valganciclovir as first-line therapy for CMV disease treatment.