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Prevymis may be alternative to Valcyte for CMV-associated uveitis

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Edmund Tsui

Thuy A. Doan

SAN FRANCISCO — Prevymis safely resolved inflammation among patients with cytomegalovirus-associated uveitis, according to a presentation at the American Academy of Ophthalmology annual meeting.

“In the United States, typical treatment for cytomegalovirus (CMV)-associated uveitis is with Valcyte (valganciclovir, Genentech) 900 mg twice daily,” Edmund Tsui, MD, assistant professor of ophthalmology at the Stein Eye Institute, David Geffen School of Medicine at the University of California, Los Angeles, told Ocular Surgery News. “Although this is an effective treatment, it carries a risk of myelosuppression and nephrotoxicity and thus requires routine laboratory monitoring.”

“Our study evaluated the off-label use of Prevymis (letermovir, Merck), a new antiviral medication that inhibits the CMV viral terminase complex, in the treatment of CMV-associated uveitis,” he added. “Importantly, letermovir does not cause myelosuppression or nephrotoxicity and eliminates the need for routine laboratory monitoring.”

The study included six eyes of five patients with persistent inflammation due to CMV-associated uveitis. All participants had severe adverse events, including cytopenias, transaminitis and persistent inflammation when treated with 900 mg of valganciclovir twice daily. They received 480 mg of letermovir daily and were followed for a mean of 9 months.

Mean visual acuity was reduced from 0.35 logMAR at baseline to 0.13 logMAR at last follow-up. Mean IOP was reduced from 14 mmHg at baseline to 9 mmHg at last follow-up.

Anterior uveitis recurred in one eye because of self-termination of letermovir. No serious side effects were reported.

At the end of the study, investigators did not observe active inflammation in any patient.

“In our retrospective, off-label study of letermovir in patients with CMV-associated uveitis, we found that letermovir 480 mg daily may be an alternative treatment in patients who have intolerable adverse effects or persistent inflammation while on valganciclovir,” Thuy A. Doan, MD, PhD, senior author and assistant professor at the Francis I Proctor Foundation at the University of California, San Francisco, told Ocular Surgery News. “Importantly, since letermovir has a different mechanism of action than valganciclovir, it could potentially be a treatment for patients with CMV-associated uveitis that have developed resistance to valganciclovir. Additional studies are needed to determine the efficacy and duration of this treatment regimen.” – by Alaina Tedesco

Reference: Tsui E, et al. Letermovir for the management of cytomegalovirus-associated uveitis. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.

Disclosure: Doan and Tsui report no relevant financial disclosures.