An overview of letermovir: a cytomegalovirus prophylactic option.

Abstract

Introduction: Human cytomegalovirus (HCMV) or human herpesvirus 5 (HHV-5) is a β-herpesvirus that causes widespread infection in nearly all members of the human population worldwide. Its persistence in humans after primary infection in a latent phase as well as a partial non-protective immune response is the basis for repeated re-activation/re-infection episodes occurring both in immunocompetent and immunocompromised subjects. In the latter patient populations, which include hematopoietic stem cell transplant (HSCT) recipients, HCMV reactivation episodes may be particularly severe, leading to both systemic and end-organ diseases. Since the 90s, at least four antiviral drugs targeting the DNA polymerase complex have been developed for the prevention and treatment of HCMV infections in transplant recipients, used as first-line (ganciclovir and valganciclovir) and second-line therapy (foscarnet and cidofovir). However, due to their toxicity and drug-resistance induction, new drugs with different targets were needed. Areas covered: In 2017, a new drug named letermovir (LTV), which targets the HCMV DNA terminase complex, was licensed for prophylaxis of HCMV infections in HSCT recipients. This is the focus of this review. Expert opinion: LTV safety and efficacy are promising. However, long-term adverse events and the emergence of drug-resistant HCMV strains must be investigated in extended clinical trials prior to drawing final conclusions.

• Authors: Giuseppe Gerna, Daniele Lilleri, Fausto Baldanti
• Journal: Expert opinion on pharmacotherapy (Expert Opin Pharmacother) Vol. 20 Issue 12 Pg. 1429-1438 (Aug 2019) ISSN: 1744-7666 [Electronic] England
• PMID: 31282759 (Publication Type: Journal Article, Review)

Chemical References

• Acetates
• Antiviral Agents
• Quinazolines
• letermovir
• Valganciclovir
• Cidofovir
• Ganciclovir

Topics

• Acetates (therapeutic use)
• Antiviral Agents (therapeutic use)
• Chemoprevention (methods, statistics & numerical data)
• Cidofovir (therapeutic use)
• Cytomegalovirus (drug effects, genetics)
• Cytomegalovirus Infections (drug therapy, epidemiology, prevention & control)
• Drug Resistance, Viral (drug effects)
• Ganciclovir (therapeutic use)
• Humans
• Immunocompromised Host (drug effects)
• Quinazolines (therapeutic use)
• Transplant Recipients (statistics & numerical data)
• Transplantation Conditioning (methods, statistics & numerical data)
• Valganciclovir (therapeutic use)