Letermovir: A promising breakthrough in CMV prevention for kidney transplant recipients Letermovir CMV Kidney Transplant CMVDisease MedicalResearch TransplantMedication OrganDonation JAMANetwork
Study: Letermovir vs Valganciclovir for Prophylaxis of Cytomegalovirus in High-Risk Kidney Transplant Recipients. Image Credit: Hospital man / Shutterstock
Letermovir, another antiviral agent, potentially overcomes all limitations of valganciclovir, like CMV-associated myelotoxicity or cross-resistance to other anti-CMV viral agents. More importantly, letermovir resistance is rare when used as a prophylactic, even for CMV infection in CMV-seropositive recipients of a hematopoietic stem cell transplant . However, it fails against herpes simplex and varicella zoster viruses and elicits unwanted drug interactions.
The team used an integrated web response system to randomize all study participants in a 1:1 ratio to receive study drug or valganciclovir, stratified based on receipt of lymphocyte-depletion eliciting immunosuppression. Also, they assigned a matching placebo to both study drugs. The primary study outcome was CMV disease up to week 52 of receiving the study drug.
Related StoriesThus, the top strata of the two-sided 95% confidence interval for the percentage variation among participants with CMV disease should not exceed 10%. The team used the stratum-adjusted Mantel-Haenszel method to compute the difference between the two study groups and their two-sided 95% CI, stratified by receipt of lymphocyte-depleting immunosuppression.
Both letermovir and valganiclovir, when given for up to 200 days after a kidney transplant, prevented CMV disease for up to 52 weeks at comparable rates of 10.4% and 11.8%. Additionally, rates of leukopenia or neutropenia were lower, favoring its use for this medical condition. Furthermore, they evaluated 52 participants for CMV DNAemia and found no letermovir-resistance–associated substitutions.
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