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


 
 
 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.
 
 
 
 Systematic searches in MEDLINE/PubMed, Embase, and conferences (from database inception to October 2021) were conducted to identify studies for inclusion. Random-effect models were used to derive pooled estimates on the relative effectiveness of letermovir PP compared to controls.
 
 
 
 Forty-eight unique studies (N = 7,104 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) of 0.13 and 0.24, p < 0.05), clinically-significant CMV infection (pOR of 0.09 and 0.19, p < 0.05), and CMV disease (pOR of 0.31 and 0.35, p < 0.05) 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 < 0.01) and non-relapse mortality (pOR = 0.65, p = 0.01) beyond day + 200 after allo-HCT.
 
 
 
 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.
