Real-World Outcomes Associated With Letermovir Use for Cytomegalovirus Primary Prophylaxis in Allogeneic Hematopoietic Cell Transplant Recipients: A Systematic Review and Meta-analysis of Observational Studies. (22nd December 2022)

• Record Type: Journal Article
• Authors: Vyas, Ami; Raval, Amit D; Kamat, Shweta; LaPlante, Kerry; Tang, Yuexin; Chemaly, Roy F
• Is Part Of: Open forum infectious diseases. Volume 10:Number 1(2023)
• Publication Date: 2022-12-22
• Subjects: allogeneic hematopoietic cell transplantation -- cytomegalovirus -- letermovir -- meta-analysis; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac687
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: A systematic review and meta-analysis of real-world observational studies was conducted to summarize the impact of letermovir cytomegalovirus (CMV) primary prophylaxis (PP) among adult allogeneic hematopoietic cell transplant (allo-HCT) recipients. Methods: Systematic searches in Medline/PubMed, Embase, and conferences (from database inception to October 2021) were conducted to identify studies for inclusion. Random-effects models were used to derive pooled estimates on the relative effectiveness of letermovir PP compared to controls. Results: Forty-eight unique studies (N = 7104 patients) were included, most of which were comparative, single-center, and conducted in the United States. Letermovir PP was associated with statistically significant reduction in odds of CMV reactivation (pooled odds ratio [pOR], 0.13 and 0.24; P < .05), clinically significant CMV infection (pOR, 0.09 and 0.19; P < .05), and CMV disease (pOR, 0.31 and 0.35; P < .05) by day +100 and day +200 after allo-HCT, respectively. Letermovir PP was associated with significantly lower odds of all-cause (pOR, 0.73; P < .01) and nonrelapse mortality (pOR, 0.65; P = .01) beyond day 200 after allo-HCT. Conclusions: Letermovir for CMV PP was effective in reducing the risk of CMV-related complications overall and mortality beyond day 200 among adult allo-HCT recipients. Abstract : We summarized and analyzed real-world effectiveness of letermovir primary prophylaxis (PP) for cytomegalovirus (CMV) reactivation, clinically significant CMV infection, CMV disease, and mortality among adult allogeneic hematopoietic cell transplant recipients. Letermovir PP reduced the risk of CMV-related complications overall, including mortality beyond day 200.