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Imlay H, Baum P, Brennan DC, Hanson KE, Hodges MR, Hodowanec AC, Komatsu TE, Ljungman P, Miller V, Natori Y, Nickeleit V, O’Rear J, Pikis A, Randhawa PS, Sawinski D, Singh HK, Westman G, Limaye AP. Consensus Definitions of BK Polyomavirus Nephropathy in Renal Transplant Recipients for Clinical Trials. Clin Infect Dis 2022; 75:1210-1216. [PMID: 35100619 PMCID: PMC9525067 DOI: 10.1093/cid/ciac071] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND BK polyomavirus (BKPyV) infection and BK polyomavirus nephropathy (BKPyVAN) are important causes of allograft dysfunction and premature allograft loss in renal transplant recipients. RESULTS AND DISCUSSION Controlled clinical trials to evaluate new agents for prevention and treatment are needed but are hampered by the lack of outcome measures that accurately assess the effect of the intervention, are clinically relevant, and are acceptable from a regulatory perspective. METHODS To facilitate consistent end points in clinical trials and to support clinical research and drug development, definitions of BKPyV infection and disease have been developed by the BK Disease Definitions Working Group of the Transplantation Associated Virus Infection Forum with the Forum for Collaborative Research, which consists of scientists, clinicians, regulators, and industry representatives. CONCLUSIONS These definitions refine established principles of "proven" BKPyV disease and introduce a "probable" disease category that could be used in clinical trials to prevent or treat BKPyVAN in renal transplant recipients.
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Affiliation(s)
- Hannah Imlay
- Correspondence: Hannah Imlay, University of Utah, 30 North 1900 East, School of Medicine, Salt Lake City, UT 84132 ()
| | - Paul Baum
- Roche Molecular Diagnostics, San Francisco, California, USA
| | - Daniel C Brennan
- Johns Hopkins Comprehensive Medical Center, Baltimore, Maryland, USA
| | - Kimberly E Hanson
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Per Ljungman
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | - Yoichiro Natori
- Department of Medicine, University of Miami Miller School of Medicine/Miami Transplant Institute, Miami, Florida, USA
| | - Volker Nickeleit
- Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jules O’Rear
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Andreas Pikis
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Parmjeet S Randhawa
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Deirdre Sawinski
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harsharan K Singh
- Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Gabriel Westman
- Swedish Medical Products Agency, Uppsala University, Uppsala, Sweden
| | - Ajit P Limaye
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Hall MD, Anderson JM, Anderson A, Baker D, Bradner J, Brimacombe KR, Campbell EA, Corbett KS, Carter K, Cherry S, Chiang L, Cihlar T, de Wit E, Denison M, Disney M, Fletcher CV, Ford-Scheimer SL, Götte M, Grossman AC, Hayden FG, Hazuda DJ, Lanteri CA, Marston H, Mesecar AD, Moore S, Nwankwo JO, O’Rear J, Painter G, Singh Saikatendu K, Schiffer CA, Sheahan TP, Shi PY, Smyth HD, Sofia MJ, Weetall M, Weller SK, Whitley R, Fauci AS, Austin CP, Collins FS, Conley AJ, Davis MI. Report of the National Institutes of Health SARS-CoV-2 Antiviral Therapeutics Summit. J Infect Dis 2021; 224:S1-S21. [PMID: 34111271 PMCID: PMC8280938 DOI: 10.1093/infdis/jiab305] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The NIH Virtual SARS-CoV-2 Antiviral Summit, held on 6 November 2020, was organized to provide an overview on the status and challenges in developing antiviral therapeutics for coronavirus disease 2019 (COVID-19), including combinations of antivirals. Scientific experts from the public and private sectors convened virtually during a live videocast to discuss severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) targets for drug discovery as well as the preclinical tools needed to develop and evaluate effective small-molecule antivirals. The goals of the Summit were to review the current state of the science, identify unmet research needs, share insights and lessons learned from treating other infectious diseases, identify opportunities for public-private partnerships, and assist the research community in designing and developing antiviral therapeutics. This report includes an overview of therapeutic approaches, individual panel summaries, and a summary of the discussions and perspectives on the challenges ahead for antiviral development.
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Affiliation(s)
- Matthew D Hall
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - James M Anderson
- Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Annaliesa Anderson
- Pfizer Vaccine Research and Development, Pfizer, Pearl River, New York, USA
| | - David Baker
- University of Washington, Seattle, Washington, USA
| | - Jay Bradner
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Kyle R Brimacombe
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | | | - Kizzmekia S Corbett
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Sara Cherry
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Emmie de Wit
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Mark Denison
- Vanderbilt University, Nashville, Tennessee, USA
| | | | | | - Stephanie L Ford-Scheimer
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | | | - Abigail C Grossman
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | | | | | | | - Hilary Marston
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Stephanie Moore
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jules O’Rear
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Celia A Schiffer
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Timothy P Sheahan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Pei-Yong Shi
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Hugh D Smyth
- University of Texas at Austin, Austin, Texas, USA
| | | | - Marla Weetall
- PTC Therapeutics, Inc, South Plainfield, New Jersey, USA
| | - Sandra K Weller
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Richard Whitley
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anthony S Fauci
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher P Austin
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - Francis S Collins
- Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Anthony J Conley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Mindy I Davis
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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3
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Natori Y, Alghamdi A, Tazari M, Miller V, Husain S, Komatsu T, Griffiths P, Ljungman P, Orchanian-Cheff A, Kumar D, Humar A, Alexander B, Avery R, Baldanti F, Barnett S, Baum P, Berrey MM, Birnkrant D, Blumberg E, Boeckh M, Boutolleau D, Bowlin T, Brooks J, Chemaly R, Chou S, Cloherty G, Cruikshank W, Dropulic L, Einsele H, Erdman J, Fahle G, Fallon L, Gillis H, Gonzalez D, Griffiths P, Gunter K, Hirsch H, Hodowanec A, Humar A, Hunt P, Josephson F, Komatsu T, Kotton C, Krause P, Kuhr F, Lademacher C, Lanier R, Lazarus T, Leake J, Leavitt R, Lehrman SN, Li L, Ljungman P, Lodding PI, Lundgren J, Martinez-Murillo F(P, Mayer H, McCutcheon M, McKinnon J, Mertens T, Miller V, Modarress K, Mols J, Mossman S, Murata Y, Murawski D, Murray J, Natori Y, Nichols G, O’Rear J, Peggs K, Pikis A, Prichard M, Razonable R, Riches M, Roberts J, Saber W, Sayada C, Singer M, Stamminger T, Wijatyk A, Yu D, Zeiher B. Use of Viral Load as a Surrogate Marker in Clinical Studies of Cytomegalovirus in Solid Organ Transplantation: A Systematic Review and Meta-analysis. Clin Infect Dis 2019; 66:617-631. [PMID: 29020339 DOI: 10.1093/cid/cix793] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/01/2017] [Indexed: 12/22/2022] Open
Abstract
Symptomatic cytomegalovirus (CMV) disease has been the standard endpoint for clinical trials in organ transplant recipients. Viral load may be a more relevant endpoint due to low frequency of disease. We performed a meta-analysis and systematic review of the literature. We found several lines of evidence to support the validity of viral load as an appropriate surrogate end-point, including the following: (1) viral loads in CMV disease are significantly greater than in asymptomatic viremia (odds ratio, 9.3 95% confidence interval, 4.6-19.3); (2) kinetics of viral replication are strongly associated with progression to disease; (3) pooled incidence of CMV viremia and disease is significantly lower during prophylaxis compared with the full patient follow-up period (viremia incidence: 3.2% vs 34.3%; P < .001) (disease incidence: 1.1% vs 13.0%; P < .001); (4) treatment of viremia prevented disease; and (5) viral load decline correlated with symptom resolution. Based on the analysis, we conclude that CMV load is an appropriate surrogate endpoint for CMV trials in organ transplant recipients.
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Affiliation(s)
- Yoichiro Natori
- Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Ali Alghamdi
- Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.,King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mahmood Tazari
- Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Veronica Miller
- Forum for Collaborative Research, University of California, Berkeley
| | - Shahid Husain
- Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Takashi Komatsu
- Division of Antiviral Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Paul Griffiths
- Institute for Immunity and Transplantation, University College London Medical School, United Kingdom
| | - Per Ljungman
- Division of Hematology, Department of Medicine Huddigne, Karolinksa Institutet, Stockholm, Sweden
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Deepali Kumar
- Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Atul Humar
- Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
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