What is the role of letermovir for prophylaxis against cytomegalovirus (CMV) disease?

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

Letermovir is an anti-CMV drug that was approved by the FDA in November 2017. It inhibits the CMV DNA terminase complex (pUL51, pUL56, and pUL89), which is required for viral DNA processing and packaging by affecting the production of proper unit length genomes and interfering with virion maturation. Approval of letermovir was based on a phase 3 clinical trial (n=565). In this study, significantly fewer patients developed clinically significant CMV infection in the letermovir group (38%, n=122/325) compared to the placebo group (61%, n=103/170). In addition, fewer patients discontinued treatment or had missing data through week 24 post-HSCT (P< 0.0001), the primary efficacy endpoint.

All-cause mortality in patients receiving letermovir was lower compared to placebo, 12% versus 17% at week 24 posttransplant. The incidence of bone marrow suppression in the letermovir group was comparable to that of the placebo group. The median time to engraftment was 19 days in the letermovir group and 18 days in the placebo group. [61]


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