Investigational treatments for cytomegalovirus infection in phase I and II study.

Introduction: The additions of letermovir and maribavir to the cytomegalovirus (CMV) armamentarium have markedly changed the landscape of CMV prevention and treatment in transplant recipients. However, their currently approved indications remain relatively restricted, and there is still a definite need for additional interventions to limit the impact of CMV in both immunocompromised and immunocompetent persons. The development of novel antivirals, vaccines, and immunotherapy-based strategies would represent significant steps toward this goal.

Areas covered: This review examines anti-CMV agents in early stage (Phase I or II) clinical trials, including expanding indications for existing agents, novel agents, vaccines, and immune-based therapies.

Expert opinion: Despite recent advances in CMV chemoprevention and treatment in transplant recipients, there remains a need for a broader, more diversified approach to mitigating the impact of CMV infection in both transplant and non-immunocompromised persons. Intravenous brincidofovir would provide an important alternative option to current antivirals in the right clinical setting. Several promising vaccine candidates are in various stages of clinical development. A safe and effective vaccine may also expand preventative strategies beyond transplant recipients and into healthy persons, specifically for the prevention of maternal-to-fetal transmission. The therapeutic possibilities of VST and TCR therapy represent important potential adjuncts to antivirals.