Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada.
Division of Infectious Disease and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transplantation. 2020 Feb;104(2):404-409. doi: 10.1097/TP.0000000000002785.
Letermovir, a new viral terminase complex inhibitor, has been approved for the prevention of cytomegalovirus (CMV) infection in hematopoietic stem cell transplant patients. However, data on the efficacy and safety of letermovir for the treatment of CMV infection in transplant recipients remain scarce.
We performed a single-center retrospective study of stem cell and organ transplant recipients who received letermovir for the treatment of CMV infection from November 2017 to October 2018.
Six patients were included, and 5 were evaluable. All received letermovir in the context of a refractory or resistant CMV infection including asymptomatic CMV viremia (n = 3), CMV syndrome (n = 1), and CMV pneumonitis and colitis (n = 1). The 3 asymptomatic patients experienced a decrease of the viral load (VL) to <200 IU/mL after letermovir therapy. One patient displayed a partial VL response (2-log of VL reduction) but a good clinical response, and one who received a suboptimal dose of letermovir experienced an increase of viremia. There were no treatment-related adverse effects.
We demonstrate mixed efficacy in patients with refractory CMV infection suggesting that letermovir may be a useful therapeutic adjunct, potentially in combination with other antivirals.
来特莫韦是一种新型病毒终止酶复合物抑制剂，已被批准用于预防造血干细胞移植患者的巨细胞病毒（CMV）感染。然而，关于来特莫韦治疗移植受者 CMV 感染的疗效和安全性的数据仍然很少。
我们对 2017 年 11 月至 2018 年 10 月接受来特莫韦治疗 CMV 感染的干细胞和器官移植受者进行了单中心回顾性研究。
共纳入 6 例患者，其中 5 例可评估。所有患者均在难治性或耐药性 CMV 感染的背景下接受来特莫韦治疗，包括无症状 CMV 病毒血症（n=3）、CMV 综合征（n=1）和 CMV 肺炎和结肠炎（n=1）。3 例无症状患者在来特莫韦治疗后病毒载量（VL）降至<200 IU/mL。1 例患者表现出部分 VL 反应（VL 降低 2 个对数）但临床反应良好，1 例接受来特莫韦剂量不足的患者出现病毒血症增加。无治疗相关不良反应。
我们在难治性 CMV 感染患者中证明了混合疗效，表明来特莫韦可能是一种有用的治疗辅助手段，可能与其他抗病毒药物联合使用。
