Which medications are used in the management of cytomegalovirus (CMV) disease?

Updated: Jul 07, 2021
  • Author: Ricardo Cedeno-Mendoza, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

There are various CMV-treatment approaches based on patient’s CMV-status and co-morbidities. Some patients receive prophylaxis while some receive preemptive therapy. Prophylaxis is given to a patient to prevent primary, reactivation or recurrent infection. Preemptive therapy is given to an asymptomatic CMV-infected patients with CMV detected by screening tests. Some studies have shown that high-dose acyclovir or valacyclovir prophylaxis markedly reduces CMV infection in allo-HSCT recipients. Intravenous ganciclovir has been also tested, with some reduction in CMV infection, however this did not provide overall survival benefit and was also associated with bone marrow suppression (ganciclovir-induced neutropenia). [43]

Letermovir, a CMV terminase inhibitor, has been used for primary prevention of CMV in sero-positive allo-HSCT recipients.  Some studies such as Marty et al, have demonstrated efficacy of it’s use, with a 23.5% reduction of CMV infection at week 24 after transplantation. This may also reduce mortality by preventing or delaying clinically significant CMV infection in these patients. [19, 61, 62]


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