Letermovir Resistance After CMV Prophylaxis Is Rare

Resistance-associated CMV mutations were not seen among kidney-transplant recipients receiving prophylactic letermovir but were seen in those receiving valganciclovir.

Letermovir was recently approved for prophylaxis in adult kidney-transplant recipients (KTRs) without prior cytomegalovirus (CMV) infection (R−) who received transplants from donors with CMV infection (D+). Letermovir's unique mechanism of action and the resistance-associated amino acid substitution (RAS) viral mutations have yet to be fully examined. Now, in a study supported by the letermovir manufacturer, plasma samples that had been collected during a prior trial of letermovir versus valganciclovir in D+/R− adult KTRs were tested with genotyping if CMV DNA was detected (see NEJM JW Infect Dis Jun 15 2023 and JAMA 2023; 330:33). Genomic regions associated with resistance to letermovir and to valganciclovir were amplified and sequenced; p…

Reviewing Author

Neil M. Ampel, MD

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Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Letermovir Resistance After CMV Prophylaxis Is Rare

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Reviewing Author