title: Letermovir for the management of cytomegalovirus infection.
abstract: Cytomegalovirus (CMV) is a major cause of morbidity and mortality in immunocompromised patients. Available antivirals are fraught with adverse effects and risk for the development of CMV resistance. Letermovir is a novel antiviral in the late stages of drug development for the treatment and prevention of CMV. Areas covered: A MEDLINE search of the MeSH terms 'letermovir,' 'cytomegalovirus,' 'hematopoietic stem cell transplant,' and 'solid organ transplant,' was last conducted on 15 August 2016. Articles were selected on the basis of their contribution to current knowledge about letermovir. Expert opinion: Letermovir's mechanism of action, pharmacokinetic and pharmacodynamic profile, and favorable efficacy and safety make it an attractive option for both the prevention and treatment of CMV in immunocompromised patients. The lack of cross-resistance with other antivirals and the absence of myelosuppression are two prominent characteristics of letermovir that could support broad use of this product following FDA-approval. One major limitation is its lack of activity against other herpesviruses, which are commonly seen in immunocompromised hosts. We believe that with additional clinical efficacy data, this medication could emerge as a primary option for the prevention and treatment of CMV in the immunocompromised patient population.
authors.affiliation: a Department of Pharmacy , Tampa General Hospital , Tampa , FL , USA.
authors.forename: Lyndsey J
authors.initials: LJ
authors.lastname: Bowman
authors.affiliation: b Department of Pharmacy , University of Rochester Medical Center , Rochester , NY , USA.
authors.forename: Jennifer Iuppa
authors.initials: JI
authors.lastname: Melaragno
authors.affiliation: c Division of Nephrology , Washington University School of Medicine , St. Louis , MO , USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
mesh_terms: D000085:Acetates / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000187:drug effects; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D015195:Drug Design; D024882:Drug Resistance, Viral; D006801:Humans; D016867:Immunocompromised Host; D011799:Quinazolines / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000085:Acetates; D000998:Antiviral Agents; D011799:Quinazolines; C000588473:letermovir
keywords: Cytomegalovirus; letermovir; terminase inhibitor; transplantation