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
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
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