[Letermovir photo]
KEY POINTS
- Letermovir (Prevymis) is a terminase complex inhibitor antiviral drug with activity versus cytomegalovirus (CMV)
- Inhibits the CMV DNA terminase complex (pUL51, pUL56, and pUL89) required for viral DNA processing and packaging
- Does not have cross-resistance with other anti-CMV drugs
- FDA-approved November 8th, 2017 for prophylaxis versus CMV infection and disease in adult patients who are CMV-seropositive recipients of an allogenic hematopoietic stem cell transplant
- FDA-approved June 6th, 2023 for CMV prophylaxis after kidney transplant in Donor CMV-seropositive/Recipient CMV-seronegative patients
- Available oral and injectable
- Same dose oral or IV as 480mg daily through 100 days post-transplant
- Package insert does not give dose adjustment for renal or mild-moderate hepatic function
- Use not recommended in severe hepatic dysfunction (Child-Pugh Class C)
- For the injectable product when creatinine clearance is below 50 mL/min the vehicle (hydroxypropyl betadex) can accumulate, so serum creatinine monitoring is recommended
- Package insert does not give dose adjustment for renal or mild-moderate hepatic function
- Tablet comes as 240mg or 480mg
- Package insert says swallow tablet whole
- Injection comes as 240mg or 480 mg vial at 20mg/mL
- Administered over 1 hour
- Same dose oral or IV as 480mg daily through 100 days post-transplant
- Contraindicated with: pimozide; ergot alkaloids; pitavastatin and simvastatin when co-administered with cyclosporine
- Letermovir interacts with numerous medications (e.g., tacrolimus, sirolimus, omeprazole, cyclosporine, atorvastatin)
- Some adverse effects reported in clinical studies include: nausea, vomiting, diarrhea, peripheral edema, cough, headache, fatigue, and abdominal pain
- Lacks myelosuppression seen with other anti-CMV medications (a benefit of letermovir)
- Reportedly tablets will cost $195.00 per day and the injection will cost $270.00 per day
RESOURCES
- Prevymis Package Insert
- Prevymis Website
- Letermovir for the management of cytomegalovirus infection (EOID 2016)
- Letermovir for cytomegalovirus prophylaxis in hematopoietic-cell transplantation (NEJM 2014)
- Cytomegalovirus disease in hematopoietic stem cell transplant patients: current and future therapeutic options (COID 2017)
- Viral infections in solid organ transplant recipients: novel updates and a review of the classics (COID 2017)