Cytomegalovirus infection in transplant recipients: newly approved additions to our armamentarium

A new direction for cytomegalovirus prophylaxis among transplant recipients: Benefits and nonviral outcomes of letermovir use as primary CMV prophylaxis

“…Retrospective, real-world data from Italy also support significantly lower rates of hospital readmission within 180 days post-HSCT (40% vs. 66%, P = 0.01) and reduced PET-associated drug costs with letermovir prophylaxis compared to historical controls [51]. Similarly, Alsumali et al also demonstrated that letermovir prophylaxis was cost-effective in terms of increasing quality-adjusted life-years (QALY) ($25 046 USD per QALY gained) and preventing cs-CMVi ($40 615 USD per infection prevented) [52 ▪ ,53]. Simulation studies in HSCT recipients have demonstrated that letermovir compared to PET was projected to increase QALY (3.29 vs. 3.08), and may have cost-saving benefits, although further cost-effectiveness analyses and insight into insurance coverage are needed given significant drug cost differences between LTV and VGCV [54 ▪ ].…”

Another tool against cytomegalovirus after allogeneic hematopoietic cell transplantation

“…Early treatment of CMV viremia can stop the progression of CMV reactivation to CMV disease. FDA-approved CMV-specific antiviral agents include ganciclovir/valganciclovir, foscarnet, cidofovir, and recently, maribavir ( Figure 1 ) ( 9 ). Despite these preventative and therapeutic methods for reducing the impact of CMV after HCT, persistent CMV reactivation and sometimes disease occur in 28% to 39% of recipients after HCT, thus motivating the development of therapeutics ( 10 , 11 ).…”

The Best Method for CMV Prevention in High-risk Kidney Transplant Recipients? Either, per National Norwegian Transplant Database: Commentary on Blom et al, Cytomegalovirus High-risk Kidney Transplant Recipients Show No Difference in Long-term Outcomes Following Preemptive Versus Prophylactic Management

“…Whether specific populations (ie, D+R− on belatacept 7 ) might benefit from one method of prevention over another merit further investigation, as does selecting the best prophylactic drug, given the recent emergence of multiple CMV-specific antiviral agents that may be useful for prophylaxis (ie, letermovir, maribavir). 8 This work by Blom et al 1 highlights the overall high rates of CMV infection even with the current best methods of prevention in the D+R− population (40% with prophylaxis, 64% with preemptive therapy), similar to what was seen with 100 d of prophylaxis in the IMPACT trial of D+R− kidney transplant recipients where 39% developed CMV disease (albeit with less routine monitoring than in this Norwegian work), although almost twice that seen with 200 d of prophylaxis in that trial at 21%. 9 This may reflect different criteria used to define infection.…”

“…Whether specific populations (ie, D+R− on belatacept 7 ) might benefit from one method of prevention over another merit further investigation, as does selecting the best prophylactic drug, given the recent emergence of multiple CMV-specific antiviral agents that may be useful for prophylaxis (ie, letermovir, maribavir). 8…”