SynthesisBMC infectious diseases2026
Beyond valganciclovir: A meta-analysis of letermovir's safety and efficacy in cytomegalovirus prophylaxis after solid organ transplantation.
Synthesis in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- The HCMV terminase as an antiviral target: structural insights, inhibitory mechanisms, and the era of letermovir.Frontiers in microbiology · 2026Review
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
backgroundCytomegalovirus (CMV) remains a major infectious cause of morbidity and graft dysfunction after solid organ transplantation (SOT). Valganciclovir (VGC) is effective for CMV prophylaxis but limited by myelotoxicity. Letermovir (LTV), a CMV terminase complex inhibitor, offers a non-myelosuppressive alternative. This meta-analysis evaluated the efficacy and safety of LTV versus VGC for CMV primary prophylaxis in SOT recipients.
methodsA systematic search of PubMed, Embase, and the Cochrane Library through October 2025 identified comparative studies of LTV and VGC in adult SOT recipients. Random-effects meta-analyses using the Mantel–Haenszel method estimated relative risks (RRs) with 95% confidence intervals (CIs). Primary endpoints were CMV disease and CMV DNAaemia during prophylaxis; secondary endpoints included post-prophylaxis CMV infection, haematologic toxicity, graft outcomes, and mortality.
resultsSix studies involving 1,413 recipients (526 LTV; 887 VGC) were included. LTV significantly reduced CMV DNAaemia during prophylaxis (RR = 0.33, 95% CI 0.18–0.59; I² = 0%), with comparable CMV disease incidence (RR = 0.87, 95% CI 0.41–1.88). Post-prophylaxis CMV infection, graft rejection, graft loss, and mortality were similar between groups. LTV showed numerically lower rates of neutropenia, leukopenia, and G-CSF use, reflecting improved haematologic safety, although between-study heterogeneity was substantial.
conclusionsLetermovir provides comparable antiviral efficacy to valganciclovir for CMV prophylaxis in SOT recipients. While trends toward improved haematologic tolerability were observed, current evidence remains limited and predominantly observational. Larger multicentre randomized trials are warranted to confirm long-term efficacy and safety across organ types. PROTOCOL REGISTRATION: The meta-analysis protocol registered with PROSPERO ID; CRD420251178234.
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