The National Institute for Health and Care Excellence (NICE) recommends letermovir (Prevymis) for the prevention of cytomegalovirus (CMV) disease after a stem cell transplant in its latest technology appraisal guidance.
Letermovir is recommended as an option for preventing CMV reactivation and disease following an allogeneic haematopoietic stem cell transplant (HSCT) in adults seropositive for CMV.
Recommended dose for letermovir is 480 mg once daily (orally or intravenously), which can be reduced to 240 mg once daily if co-administered with cyclosporin A. Therapy may be initiated on the day of transplant or any time up to 28 days after the transplant and should be continued for 100 days after transplant.
Currently, regular blood testing is conducted to monitor CMV levels (with or without aciclovir) after an allogeneic HSCT. If CMV levels are elevated, treatment with ganciclovir, valganciclovir or foscarnet (pre-emptive therapy) is initiated; however, these drugs are often associated with severe side effects. Evidence shows that letermovir can effectively decrease CMV infection and the requirement for pre-emptive therapy.
The drug should be used only when provided by the company in agreement with the commercial arrangement. The recommendation should not affect patients whose treatment with the drug was started before the publication of the guidance.