Pakpoom Phoompoung1,2, Victor H Ferreira1, Jussi Tikkanen1, Shahid Husain1, Auro Viswabandya3, Deepali Kumar1, Atul Humar1. 1. Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada. 2. Division of Infectious Disease and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 3. Hans Messner Allogeneic Transplant Program, University Health Network, Toronto, ON, Canada.
Abstract
BACKGROUND: Letermovir, a new viral terminase complex inhibitor, has been approved for the prevention of cytomegalovirus (CMV) infection in hematopoietic stem cell transplant patients. However, data on the efficacy and safety of letermovir for the treatment of CMV infection in transplant recipients remain scarce. METHODS: We performed a single-center retrospective study of stem cell and organ transplant recipients who received letermovir for the treatment of CMV infection from November 2017 to October 2018. RESULTS: Six patients were included, and 5 were evaluable. All received letermovir in the context of a refractory or resistant CMV infection including asymptomatic CMV viremia (n = 3), CMV syndrome (n = 1), and CMV pneumonitis and colitis (n = 1). The 3 asymptomatic patients experienced a decrease of the viral load (VL) to <200 IU/mL after letermovir therapy. One patient displayed a partial VL response (2-log of VL reduction) but a good clinical response, and one who received a suboptimal dose of letermovir experienced an increase of viremia. There were no treatment-related adverse effects. CONCLUSIONS: We demonstrate mixed efficacy in patients with refractory CMV infection suggesting that letermovir may be a useful therapeutic adjunct, potentially in combination with other antivirals.
BACKGROUND: Letermovir, a new viral terminase complex inhibitor, has been approved for the prevention of cytomegalovirus (CMV) infection in hematopoietic stem cell transplant patients. However, data on the efficacy and safety of letermovir for the treatment of CMV infection in transplant recipients remain scarce. METHODS: We performed a single-center retrospective study of stem cell and organ transplant recipients who received letermovir for the treatment of CMV infection from November 2017 to October 2018. RESULTS: Six patients were included, and 5 were evaluable. All received letermovir in the context of a refractory or resistant CMV infection including asymptomatic CMV viremia (n = 3), CMV syndrome (n = 1), and CMV pneumonitis and colitis (n = 1). The 3 asymptomatic patients experienced a decrease of the viral load (VL) to <200 IU/mL after letermovir therapy. One patient displayed a partial VL response (2-log of VL reduction) but a good clinical response, and one who received a suboptimal dose of letermovir experienced an increase of viremia. There were no treatment-related adverse effects. CONCLUSIONS: We demonstrate mixed efficacy in patients with refractory CMV infection suggesting that letermovir may be a useful therapeutic adjunct, potentially in combination with other antivirals.
Authors: Seema A Mehta Steinke; Mona Alfares; Alexandra Valsamakis; Shmuel Shoham; Ravit Arav-Boger; Laura Lees; Darin Ostrander; Michael S Forman; Audra Shedeck; Richard F Ambinder; Richard John Jones; Robin K Avery Journal: Transpl Infect Dis Date: 2020-12-02
Authors: Elena Rho; Bettina Näf; Thomas F Müller; Rudolf P Wüthrich; Thomas Schachter; Seraina von Moos Journal: Clin Transplant Date: 2021-10-28 Impact factor: 3.456