Cytomegalovirus Medication

  • Author: Kauser Akhter, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 17, 2011
 

Medication Summary

The goals of pharmacotherapy are to prevent outbreaks of the disease and its complications and to reduce morbidity. Several agents are currently available for the treatment of cytomegalovirus (CMV) infection and disease.

In addition, multiple agents are in development for CMV treatment.[60] These include (1) maribavir, an agent currently in a phase III randomized controlled trial with ganciclovir for CMV disease prevention in orthotopic liver transplant recipients; (2) CMX001 (hexadecyloxypropyl-cidofovir, an ester of cidofovir), which is under development as an oral treatment for smallpox; and (3) leflunomide, a pyrimidine synthesis inhibitor.[60] Leflunomide has been successfully used in solid organ transplant recipients for both CMV treatment and prophylaxis. Unfortunately, leflunomide failure has been reported in hematopoietic stem cell transplant recipients.[58]

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Antivirals

Class Summary

CMV is a double-stranded DNA virus. Drugs currently used for the treatment of DNA viral infections affect the viral DNA polymerase and affect viral DNA replication.

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Ganciclovir (Cytovene®)

 

Synthetic guanine derivative nucleoside analog active against CMV. Inhibits replication of herpes viruses both in vitro and in vivo.

In patients with HIV infection, resistance manifests as progressive disease. An oral formulation (valganciclovir) exists and is used for prophylaxis of CMV infection, but it should not be used for initial treatment of acute infection (except, perhaps, CMV retinitis). The oral version achieves serum levels comparable to those of the IV version.

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Valganciclovir (Valcyte™)

 

L-valyl ester prodrug of ganciclovir.

Used for CMV disease prophylaxis in various solid organ transplant recipients. Inhibits replication of human CMV in vitro and in vivo.

Achieves serum levels comparable to those obtained with IV ganciclovir.

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Foscarnet (Foscavir®)

 

Inhibits viral replication of herpesviruses (CMV, HSV-1, HSV-2) at pyrophosphate-binding site on virus-specific DNA polymerases. Used for ganciclovir-resistant CMV retinitis and herpes simplex disease.

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Cidofovir (Vistide®)

 

Approved for treatment of CMV retinitis in AIDS. Nucleotide analog, whose active metabolite inhibits herpes virus polymerases at concentrations that are 8- to 600-fold lower than those needed to inhibit human cellular DNA polymerases alpha, beta, and gamma. Incorporation of cidofovir into the growing viral DNA chain results in reductions in the rate of viral DNA synthesis.

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Antimetabolite

Class Summary

These agents inhibit cell growth and proliferation.

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Leflunomide (Arava®)

 

Leflunomide has been used off-label in the treatment of cytomegalovirus (CMV) disease in transplant recipients, as well as in the prevention of acute and chronic rejection in recipients of solid organ transplants

Inhibits pyrimidine synthesis (via dihydroorotate dehydrogenase inhibition), leading to immunomodulatory and antiproliferative activity

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Immune Globulin

Class Summary

Consists of administration of immunoglobulin pooled from serum of immunized subjects.

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Cytomegalovirus immune globulin (CMV IG)

 

CMV immune globulin (CMV-IG) is a preparation of immunoglobulin derived from pooled healthy blood donors with high CMV titers; administration provides a passive source of antibodies against cytomegalovirus. Used for CMV pneumonia treatment. May also be used for CMV prophylaxis in heart, lung, kidney, liver and pancreas transplant recipients, in addition to ganciclovir.

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Contributor Information and Disclosures
Author

Kauser Akhter, MD  Clinical Assistant Professor, Department of Internal Medicine, Florida State University College of Medicine; Infectious Diseases Faculty Practice, Orlando Health

Disclosure: Nothing to disclose.

Coauthor(s)

Todd S Wills  MD, Associate Professor, Department of Medicine, Division of Infectious Disease and International Medicine, Program Director, Infectious Disease Fellowship Program, University of South Florida College of Medicine

Todd S Wills is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Douglas A Drevets, MD  Assistant Professor, Department of Medicine, Section of Infectious Disease, Oklahoma University Health Sciences Center

Douglas A Drevets, MD is a member of the following medical societies: American Association of Immunologists, American Society for Microbiology, Central Society for Clinical Research, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

John W King, MD  Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi

Disclosure: emedicine $50.00 Author of chapter; MERCK None Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Todd S Wills, MD to the development and writing of this article.

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Here, using immunofluorescent technique, a specimen of human embryonic lung (25X) reveals the presence of cytomegalovirus. Courtesy of the CDC/Dr. Craig Lyerla.
Hematoxylin-eosin–stained lung section showing typical owl-eye inclusions (480X). Courtesy of Danny L Wiedbrauk, PhD, Scientific Director, Virology & Molecular Biology, Warde Medical Laboratory, Ann Arbor, Michigan.
 
 
 
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