Korean J Transplant.  2022 Nov;36(Supple 1):S267. 10.4285/ATW2022.F-4062.

Safety and efficacy of letermovir for cytomegalovirus prophylaxis in allogeneic hematopoietic stem cell transplantation

• Jahan RN
• Azharuddin M

• KMID: 2535494
• DOI: http://doi.org/10.4285/ATW2022.F-4062

Abstract

Background
The existing studies investigated the effect of different antiviral agents for cytomegalovirus (CMV) prophylaxis in hematopoietic stem cell transplantation (HSCT). However, there is scarce of evidence on letermovir used for CMV prophylaxis. The objective of this study was to conduct a systematic literature review and meta-analysis to examine the impact of letermovir used for CMV prophylaxis in HSCT.
Methods
A systematic literature search in PubMed/Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar with pairing relevant keywords to identify English language articles. The eligible studies examine the im-pact of letermovir used for CMV prophylaxis in HSCT. The meta-analysis was carried out using Review Manager ver. 5.3. Ran-dom effects model was used to compute the pooled estimates of risk ratios (RRs) and 95% confidence intervals (CIs).
Results
A total of 260 participants with a median age of 54.13 years (range, 17–78 years) were included. Results from meta-analysis showed that prophylaxis letermovir significantly reducing the incidence of CMV infection versus placebo/control (RR, 0.49; 95% CI, 0.41–0.59; P<0.001) and control group (RR, 0.49; 95% CI, 0.41–0.58; P<0.001), respectively. However, prophylaxis letermo-vir did not significantly reduce the incidence of CMV infection versus placebo (RR, 0.60; 95% CI, 0.35–1.04; P=0.07). The prophy-laxis letermovir almost reduces the all-cause mortality versus control group in reducing (RR, 0.77; 95% CI, 0.60–1.00; P=0.05). No significant difference found between letermovir group and control group in serious adverse events (RR, 0.91; 95% CI, 0.78–1.05; P=0.20). Moreover, significant difference found between letermovir group and placebo in incidence of all-cause prophylaxis failure (P=0.002).
Conclusions
Evidence from current synthesis, showed that prophylaxis letermovir significantly reduce the incidence of CMV infection. All-cause prophylaxis failure was dose dependent. However, further randomized controlled trials with long-term fol-low-up are required to confirm the current findings.