Letermovir Dosing for CMV Prophylaxis in Kidney Transplant Recipients

Standard Dosing Regimen

• The National Comprehensive Cancer Network recommends reducing the dose of letermovir to 240 mg once daily when co-administered with cyclosporine due to drug-drug interactions that increase letermovir exposure 1, 2, 3
• Initiate letermovir between day 0 through day 28 post-transplant and continue through day 100-200 post-transplant 1, 2, 3

Important Clinical Considerations

• The National Comprehensive Cancer Network notes that letermovir does not require dose adjustment for renal function, and no nephrotoxicity or myelosuppression has been observed with letermovir 1, 2, 3
• Letermovir lacks activity against HSV and VZV, so concurrent acyclovir or valacyclovir prophylaxis must be continued 4, 5
• Rapid emergence of resistant mutants can occur if letermovir is interrupted, underdosed, or in high-risk patients 1, 2, 3
• Always reduce dose to 240 mg daily with cyclosporine co-administration 1, 2, 3

Context: Current Standard of Care

• The KDIGO guidelines recommend 6 weeks of CMV chemoprophylaxis with valganciclovir after T-cell-depleting antibody therapy for rejection treatment, but letermovir represents an important alternative when myelosuppression from valganciclovir is problematic or anticipated, or renal function is severely impaired 6, 7