What is the treatment for Cytomegalovirus (CMV) infection?

From the Guidelines

For severe CMV disease or in immunocompromised patients, first-line treatment is intravenous ganciclovir at 5 mg/kg every 12 hours for 2-3 weeks, followed by oral valganciclovir 900 mg daily for maintenance. This recommendation is based on the most recent and highest quality study available, which suggests that ganciclovir and valganciclovir are the agents of choice for first-line pre-emptive therapy 1.

Treatment Options

• Intravenous ganciclovir at 5 mg/kg every 12 hours for 2-3 weeks, followed by oral valganciclovir 900 mg daily for maintenance
• Alternative medications include foscarnet (90 mg/kg every 12 hours) for ganciclovir-resistant cases or cidofovir (5 mg/kg once weekly) when other options fail
• Letermovir (480 mg daily) is used for prophylaxis in stem cell transplant recipients

Important Considerations

• Treatment should include regular monitoring of viral load, kidney function, and blood counts as these medications can cause significant side effects including nephrotoxicity and bone marrow suppression
• Hydration is essential when administering foscarnet or cidofovir to reduce kidney damage
• CMV-specific immunoglobulin may be added in severe cases, particularly in transplant recipients
• These antiviral medications work by inhibiting viral DNA polymerase, preventing viral replication in infected cells

Patient-Specific Factors

• Immunocompetent patients with mild symptoms may not require treatment as the infection typically resolves on its own
• Immunocompromised patients, such as those undergoing allogeneic HCT or receiving T-cell depleting therapies, are at higher risk for CMV reactivation and disease
• Patients with lymphoproliferative malignancies, patients receiving T-cell suppressive therapy with purine analogs, and patients receiving alemtuzumab therapy are also at risk for CMV infections 1

From the FDA Drug Label

1 INDICATIONS & USAGE 1.1 Adult Patients Treatment of Cytomegalovirus (CMV) Retinitis: Valganciclovir tablets, USP are indicated for the treatment of CMV retinitis in patients with acquired immunodeficiency syndrome (AIDS) [see Clinical Studies ( 14. 1)]. Prevention of CMV Disease: Valganciclovir tablets, USP are indicated for the prevention of CMV disease in kidney, heart, and kidney-pancreas transplant patients at high risk (Donor CMV seropositive/Recipient CMV seronegative [D+/R-]) [see Clinical Studies ( 14.1)].

The treatment for Cytomegalovirus (CMV) infection is valganciclovir tablets, which are indicated for the:

• Treatment of CMV retinitis in patients with acquired immunodeficiency syndrome (AIDS)
• Prevention of CMV disease in kidney, heart, and kidney-pancreas transplant patients at high risk (Donor CMV seropositive/Recipient CMV seronegative [D+/R-]) 2

From the Research

Treatment Options for Cytomegalovirus (CMV) Infection

The treatment for CMV infection typically involves the use of antiviral drugs. The following are some of the treatment options:

• Ganciclovir, an antiviral drug that can be administered intravenously or orally 3, 4
• Valganciclovir, an oral prodrug of ganciclovir with improved bioavailability 3, 4
• Foscarnet, an antiviral drug that can be used to treat CMV infection, especially in cases where ganciclovir is not effective 3, 4
• Cidofovir, an antiviral drug that can be used to treat CMV infection, especially in cases where other treatments have failed 3, 4
• Maribavir, a novel antiviral drug that has shown promise in treating CMV infection 5, 6
• Brincidofovir and letermovir, new antiviral drugs that are being developed to treat CMV infection 5
• CMV immunoglobulin (CMVIG), which can be used as an adjunctive treatment or alternative to antiviral drugs in certain cases, such as ganciclovir intolerance or antiviral-resistant CMV 7

Special Considerations

In certain cases, such as thoracic transplant recipients, CMVIG may be considered as an addition or alternative to antiviral treatment 7. The use of CMVIG may be indicated in cases of:

• Ganciclovir-resistant infection
• Serious or complicated cases, such as pneumonitis or eye complications
• Patients with a positive biopsy in end organs, such as the lung or stomach
• Symptomatic cases with rising polymerase chain reaction values despite antiviral treatment
• CMV disease or CMV infection or risk factors, such as CMV-IgG-negative serostatus
• Ganciclovir intolerance
• Patients with hypogammaglobulinemia 7