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Review
. 2024 Apr;25(6):685-694.
doi: 10.1080/14656566.2024.2353627. Epub 2024 May 16.

Advances in pharmacotherapies for cytomegalovirus infection: what is the current state of play?

Lea M Monday  1 , Vishakh Keri  1 , Pranatharthi H Chandrasekar  1
Affiliations
Review

Advances in pharmacotherapies for cytomegalovirus infection: what is the current state of play?

Lea M Monday et al. Expert Opin Pharmacother. 2024 Apr.

Abstract

Introduction: Cytomegalovirus (CMV) remains a serious opportunistic infection in hematopoietic cell transplant (HCT) and solid-organ transplant (SOT) recipients. Traditional anti-CMV drugs are limited by toxicities and the development of resistance. Letermovir and maribavir are newly approved antivirals for the prevention and treatment of CMV.

Areas covered: Prior reviews have discussed use of letermovir for prevention of CMV after HCT and maribavir for resistant or refractory (R/R) CMV post HCT or SOT. Subsequent data have expanded their use including letermovir for primary CMV prophylaxis in high-risk renal transplant recipients and new recommendations for extending prophylaxis through day + 200 in certain HCT patients. Data on the use of maribavir for first asymptomatic CMV infection post-HCT has also been published. This review compares the pharmacology of anti-CMV agents and discusses the updated literature of these new drugs in the prevention and treatment of CMV.

Expert opinion: Letermovir and maribavir are much needed tools that spare toxicities of ganciclovir, foscarnet, and cidofovir. High cost is a challenge preventing their integration into clinical practice in resource-limited countries. Transplant centers need to exercise restraint in overuse to avoid resistance, particularly in the setting of high viral loads.

Keywords: Cytomegalovirus; letermovir; maribavir; organ transplantation; stem cell transplantation; viral infection.

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