Letermovir-based Dual Therapy for Treatment of Cytomegalovirus Infections

Launched by ASSISTANCE PUBLIQUE - HÔPITAUX DE PARIS · Mar 25, 2024

Keywords

ClinConnect Summary

This clinical trial is studying a new treatment approach for patients who have a cytomegalovirus (CMV) infection after receiving a kidney transplant. The trial will test the effectiveness and safety of using letermovir in combination with another medication called valganciclovir to treat these infections. The goal is to help kidney transplant recipients who have a high level of CMV DNA in their blood and need antiviral treatment.

To be eligible for this trial, participants must be at least 18 years old, weigh at least 30 kg, and have a confirmed CMV infection. They should also be able to take oral valganciclovir, meaning they are not currently on other antiviral treatments for more than 72 hours. Participants can expect to receive close monitoring throughout the study and will need to provide informed consent. It's important to note that individuals who are pregnant, breastfeeding, or have certain medical conditions may not be able to participate. Overall, this study aims to find a better way to treat CMV infections in kidney transplant patients, which could improve their health outcomes.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Age ≥ 18 years
• • 2. Weight ≥ 30 kg
• • 3. Kidney transplant recipient
• • 4. Have a documented CMV infection or disease, with (i) a screening value of CMV DNA ≥ 3000 IU/mL in whole blood or plasma in 2 consecutive assessments separated by ≥ 1 day, as determined by local laboratory quantitative polymerase chain reaction (qPCR). Both samples should be taken within 14 days prior to randomization with the second sample obtained within 5 days prior to randomization OR (ii) a screening value of CMV DNA ≥ 30000 IU/mL in whole blood or plasma, as determined by local laboratory quantitative polymerase chain reaction (qPCR), in 1 sample obtained within 5 days prior to randomization
• • 5. Eligible for treatment with oral valganciclovir, per investigator's judgment
• • 6. For patients of childbearing age (following menarche): negative bHCG and effective method of contraception (sexual abstinence, hormonal contraception containing ethinylestradiol and levonorgestrel, intrauterine device or hormone-releasing system, cap, diaphragm or sponge with spermicide, condom) until 30 days after the end of relevant systemic exposure (week 13).
• • For male an effective method of contraception (sexual abstinence, condom) until 90 days after the end of relevant systemic exposure (week 13).
• • 7. Have life expectancy of ≥ 8 weeks
• • 8. French speaking
• • 9. Affiliated to social security regime or an equivalent system
• • 10. Informed consent and signed
• Exclusion Criteria:
• • 1. Have a current CMV infection that is considered refractory or resistant due to inadequate adherence to antiviral treatment, to the best knowledge of the investigator.
• • 2. Have a CMV infection that is known to be genotypically resistant to valganciclovir and/or letermovir on documented evidence.
• • 3. Be on treatment with anti-CMV agents (ganciclovir, valganciclovir, foscarnet, cidofovir, letermovir or maribavir) for the current CMV infection for longer than 72 hours. However, patients experiencing CMV infection while receiving ganciclovir or valganciclovir prophylaxis (i.e. at prophylactic dosages) or letermovir prophylaxis can be included.
• • 4. Have an eGFR \< 30 mL/min/1.73m² (using the CKD-EPI Creatinine Equation (2009)).
• • 5. Have serum aspartate aminotransferase (AST) ≥ 5 times higher than the upper limit of normal (ULN), or serum alanine aminotransferase (ALT) ≥ 5 times the ULN, or total bilirubin ≥ 3 times the ULN (except for documented Gilbert's syndrome). Note: Subjects with biopsy confirmed CMV hepatitis will not be excluded from study participation despite AST or ALT ≥ 5 times ULN
• • 6. Have a severe chronic liver disease (Child-Pugh Class C)
• • 7. Have a known human immunodeficiency virus (HIV) infection with plasma HIV RNA ≥ 50 copies/mL within the 3 months before inclusion.
• • 8. Require mechanical ventilation or vasopressors for hemodynamic support.
• • 9. Be pregnant or breastfeeding.
• • 10. Have received anti-CMV vaccine at any time.
• • 11. Be receiving leflunomide or artesunate when study treatment is initiated.
• • 12. Be receiving strong inhibitors or inducers of hepatic CYP enzymes including rifampicin, phenytoin, clarithromycin, ritonavir, or cobicistat or St. John's wort (Hypericum perforatum) when study treatment is initiated.
• • 13. Be receiving efavirenz, etravirine, nevirapine, lopinavir, pimozine, ergot alkaloids, dabigatran, atorvastatine, simvastatine, rosuvastatine, pitavastatine or imipenem-cilastatine when study treatment is initiated.
• • 14. Have known hereditary intolerance to galactose, with lactose Lapp deficiency, glucose or galactose malabsorption syndrome.
• • 15. Have known hypersensitivity to letermovir or to an excipient for a study treatment.
• • 16. Have any clinically significant medical or surgical condition that in the investigator's opinion could interfere with the interpretation of study results, contraindicate the administration of the assigned study treatment, or compromise the safety or well-being of the subject.
• • 17. Participation to another clinical trial on medicinal products for human use
• • 18. Have an absolute neutrophil count less than 500 cells/µl, or platelet count less than 25,000/µl, or haemoglobin less than 8 g/dl