Letermovir Salvage in Resistant Cytomegalovirus Infection

Patients with cytomegalovirus (CMV) disease have few treatment options upon ganciclovir failure, but letermovir salvage might be a feasible option for some patients, according to a presentation given by researchers from Duke University at ID Week 2018. Letermovir is approved as prophylaxis for CMV infection and disease in adult CMV-seropositive recipients of an allogeneic hematopoietic stem cell transplantation. The assessment by Duke researchers sought to determine letermovir’s efficacy as a treatment of CMV disease or as a secondary prophylaxis, which are not current indications.

The researchers analyzed data from their institution between 11/2017 and 4/2018 and identified 4 patients who received letermovir as a CMV treatment and 1 who received it for the secondary suppression of CMV DNAemia and CMV retinitis. All patients had proven genotypic resistance with complications or clinical failure on prior antivirals. Three patients received concomitant CMV immune globulin and intravitreal therapy with foscarnet with or without ganciclovir. All 5 patients showed clinical and retinoscopic improvement; however, 2 patients did not achieve complete resolution of DNAemia.

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Reference

Turner N, Strand A, Saullo J, et al. Letermovir salvage for complicated cases of resistant CMV. Presented at: 2018 ID Week; October 3-7, 2018; San Francisco, California. Abstract 1897.