Cytomegalovirus Therapy: Role of Letermovir in Prophylaxis and Treatment in Transplant Recipients.

Journal Article (Journal Article;Review)

Cytomegalovirus (CMV) is a common viral pathogen in the transplant population and is associated with significant morbidity and mortality. CMV prevention is paramount; however, selecting the best preventive strategy depends on many factors including donor-recipient CMV serostatus, transplant-specific risks, antiviral toxicities and cost. Novel CMV therapeutics such as letermovir (LTV) are desperately needed to optimize CMV management. Uniquely among CMV antiviral therapies, LTV inhibits the viral terminase complex in the CMV DNA synthesis pathway and disrupts viral genome packaging. Further, it lacks side effects frequently associated with other CMV antiviral therapies and evades common mechanisms of resistance. LTV is approved by the US Food and Drug Administration for CMV prevention in adult CMV-seropositive hematopoietic cell transplant recipients but is increasingly applied off-label for prophylaxis and treatment. This review summarizes important concepts of CMV management in transplantation, with a specific focus on LTV pharmacology and clinical experience to date alongside future prospects for its application.

Full Text

Duke Authors

Cited Authors

  • Saullo, JL; Miller, RA

Published Date

  • January 27, 2023

Published In

Volume / Issue

  • 74 /

Start / End Page

  • 89 - 105

PubMed ID

  • 36332639

Electronic International Standard Serial Number (EISSN)

  • 1545-326X

Digital Object Identifier (DOI)

  • 10.1146/annurev-med-042921-124739


  • eng

Conference Location

  • United States