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In 2012, around 19,500 kidney transplant operations were performed in the UK and USA. The greatest infection risk to transplant recipients is from cytomegalovirus (CMV), the standard 2-4 week treatment for which involves an average of 5 days as an inpatient, which can cost up to £13,000. University of Glasgow research has led to revised standards of care for the prevention and treatment of CMV disease in kidney transplant recipients (KTRs). First, that antiviral treatment with oral valganciclovir for 200 days can be used to prevent CMV disease in postoperative KTRs and is twice as effective as treatment for 100 days. Secondly, the team found that the use of oral valganciclovir was a practical and cost-effective alternative to intravenous ganciclovir for treatment of mild CMV disease in solid-organ transplant recipients. Since 2009, the use of these therapies has been recommended in key national and international guidelines for the care of KTRs. The research also provided the evidence base that was used for evaluating, and subsequently amending, the marketing authorisation of oral valganciclovir for use in preventative treatment of CMV disease in KTRs in the UK and USA.
COPD affects up to 3.5 million people in the UK and costs the NHS £700m pa. Over the last 15 years, research by Professor Calverley and colleagues at the University of Liverpool (UoL) has impacted significantly on the care of COPD patients. Specifically, this group showed that routine testing of COPD patients for the presence of bronchodilator reversibility was unreliable and did not predict clinical outcomes. This changed international guideline recommendations in 2007 and the Quality Outcomes Framework payments to GPs in 2009. They showed that oral corticosteroids accelerated recovery from exacerbations and that anti-inflammatory drugs, whether inhaled corticosteroids or PDEIV inhibitors, reduced exacerbations by 25% with a subsequent fall in the number and length of hospitalisations. This led to changed NICE guidance for corticosteroids in 2010 and drug registration with EMA and FDA for the PDEIV inhibitor treatment in 2011. Treatment in UK and Western Europe has changed as a result of this research.
Scientists at the Liverpool School of Tropical Medicine (LSTM) have proven that targeting an essential bacterial symbiont, Wolbachia, with a course of antibiotics cures patients of their parasitic worms and improves disease pathology. This discovery in 1999 offers superior efficacy compared to existing anti-filarial drugs delivering prophylaxis, transmission blocking, safe macrofilaricidal activity and improved case management therapy. This approach has been endorsed by WHO elimination programmes for onchocerciasis, (Onchocerciasis Elimination Programme for the Americas, OEPA) and lymphatic filariasis (Global Programme to Eliminate Lymphatic Filariasis, GPELF). The Centre for Disease Control (CDC), also recommends this new strategy for elimination and morbidity management.
Research led by University of Oxford scientists has resulted in widespread use of the humanised therapeutic antibody, Campath (alemtuzumab), in patients with chronic lymphocytic leukaemia (CLL). Licensed by both the European and American regulatory authorities in 2004 for the treatment of CLL, Campath is used as first-line treatment for patients with aggressive forms of the disease and following relapse. It can induce long-term clinical remission even in cases resistant to other drugs. Campath has now been used in approximately 15,000 patients, and has generated revenues of approximately £750 million from the licensed treatment of CLL.
The human influenza A (H5N1) infection emerged in China in 2003 and quickly spread throughout Asia, killing more than half of those infected. Researchers at the Oxford University Clinical Research Unit in Vietnam (OUCRU) provided rapid information to the World Health Organization (WHO) on the pathological and clinical features of H5N1 infection in humans, as it emerged in Vietnam. The WHO used this front line information to inform recommendations for the investigation, diagnosis, management, and treatment of H5N1 globally, ultimately reducing mortality by up to 19%.
Researchers from St Georges have evaluated and optimised anti-fungal therapy for cryptococcal meningitis, the commonest cause of adult meningitis in sub-Saharan Africa. They have developed a "screen-and-treat" strategy to prevent the development of clinical disease in HIV-positive patients, and with collaborators developed and tested a novel point-of-care diagnostic test. These advances have led to changes in and development of a series of international guidelines and application of these new strategies in parts of Africa. A case for reduced costs of amphotericin was advanced by the group who were instrumental in reducing these costs in South Africa, allowing wider drug provision.
Impact: Health and welfare and public healthcare policy; demonstrating that community-directed treatment of onchocerciasis with doxycycline is effective where ivermectin is contra-indicated.
Significance: 12,936 onchocerciasis patients were treated safely and protected for at least 4 years. The treatment regime has been adopted by the US Centers for Disease Control and Prevention, the World Health Organization and governments.
Beneficiaries: Patients with onchocerciasis; governments and policy-makers.
Attribution: Studies performed by a long-standing African-European partnership formed and led by Taylor (UoE).
Reach: International; up to 8 million people in the Congo basin; onchocerciasis patients in Africa where ivermectin is not appropriate plus those in South America participating in focal eradication campaigns.
Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness. Research by Professors David Mabey and Robin Bailey, LSHTM, has shown that a single oral dose of azithromycin is an effective, feasible mass treatment and could eliminate trachoma from affected communities. As a result, the manufacturer Pfizer agreed to donate azithromycin to trachoma control programmes for as long as necessary and WHO established an Alliance for the Global Elimination of Blinding Trachoma by 2020. Since 2008, 205m azithromycin doses have been donated, and WHO elimination targets have been achieved in nine countries.
The University of Oxford's International Subarachnoid Aneurysm Trial (ISAT) changed clinical practice worldwide by showing that endovascular coiling is a more effective and safer treatment than neurosurgery following subarachnoid haemorrhage, with fewer complications and improved quality of life. Subarachnoid haemorrhages account for 1 in 14 strokes and are caused by bleeding in and around the brain; approximately 85% occur when cerebral aneurysms rupture. ISAT was the first trial to compare neurosurgery, or neuroradiological endovascular coiling in patients with ruptured cerebral aneurysms causing acute subarachnoid haemorrhage.
Research at the University of Liverpool (UoL) has demonstrated the importance of intestinal tapeworm infection as an important and hitherto unrecognised risk factor for a major life-threatening acute intestinal disease (colic) in the horse. A novel serological test for exposure to the tapeworm infection was developed at UoL to provide a diagnostic tool for research and clinical applications. As a result, "best practice" equine preventive healthcare programmes now include anti-helminth and tapeworm control protocols and anti-tapeworm anthelmintics are licensed for use in the horse and marketed throughout the world. This research has had a major impact on equine health resulting in welfare and economic benefits for horses, their owners, veterinary practices and industry.