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

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES
Current Opinion in Infectious Diseases Pub Date : 2023-12-01 Epub Date: 2023-09-29 DOI:10.1097/QCO.0000000000000983
W Justin Moore, Catherine-Audrey Boutin, Sajal Tanna
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引用次数: 1

Abstract

Purpose of review: Letermovir has changed the game of primary prophylaxis against cytomegalovirus (CMV) for hematopoietic stem cell transplant (HSCT) and more recently, solid organ transplant recipients. This is largely due to letermovir's similar efficacy in protecting against CMV reactivation and disease, along with its superior safety profile, notably reduced myelotoxicity, and lack of renal dose adjustment compared to standard agents like valganciclovir. This review will describe the potential benefits and clinical considerations of letermovir as prophylaxis among transplant recipients, with a focus on recent evidence describing nonviral outcomes of CMV.

Recent findings: Recent evidence has demonstrated improved safety (e.g., less myelosuppression) and tolerability with no difference in rates of CMV infection or disease in kidney transplant recipients given letermovir compared to valganciclovir. Real-world studies and meta-analyses in HSCT populations have explored various nonviral outcomes with letermovir use. Letermovir prophylaxis was associated with reduced mortality, lower rates of graft versus host disease, delayed CMV immune reconstitution, improved tolerability with extended durations, and decreased healthcare utilization.

Summary: Letermovir is an effective antiviral agent for CMV prevention and has demonstrated enhanced safety, which may allow for extended durations of primary prophylaxis among transplant recipients along with other improved clinical outcomes by mitigating the indirect effects of CMV.

在移植受者中预防巨细胞病毒的新方向:使用莱特莫韦作为主要巨细胞病毒预防的益处和非病毒结果。
综述目的:Letermovir改变了造血干细胞移植(HSCT)和最近的实体器官移植受者对巨细胞病毒(CMV)的一级预防游戏。这在很大程度上是因为与缬更昔洛韦等标准药物相比,莱特莫韦在预防CMV再激活和疾病方面具有相似的疗效,同时其优越的安全性,显著降低了骨髓毒性,并且缺乏肾脏剂量调整。这篇综述将描述莱特莫韦作为移植受者预防的潜在益处和临床考虑,重点关注描述CMV非病毒性结果的最新证据。最近的发现:最近的证据表明,与缬更昔洛韦相比,给予莱特莫韦的肾移植受者的CMV感染率或疾病率没有差异,安全性(例如,骨髓抑制较少)和耐受性得到了改善。在HSCT人群中进行的真实世界研究和荟萃分析已经探索了使用莱特莫韦的各种非病毒结果。Letermovir预防与死亡率降低、移植物抗宿主病发生率降低、CMV免疫重建延迟、耐受性延长和医疗利用率降低有关。摘要:Letermovir是一种有效的预防巨细胞病毒的抗病毒药物,已证明其安全性增强,这可能会延长移植受者的初级预防时间,并通过减轻巨细胞病毒的间接影响来改善其他临床结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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