Letermovir for preventing cytomegalovirus disease after a stem cell transplant

Letermovir (Prevymis, Merck, Sharpe & Dohme) is indicated 'for the prophylaxis of cytomegalovirus (CMV) reactivation and disease in adult CMV-seropositive [R+] recipients of an allogeneic haematopoietic stem cell transplant'.

The recommended dose of letermovir is 480 mg once daily (oral tablets and solution for intravenous infusion), decreasing to 240 mg once daily if co‑administered with cyclosporin A.

Treatment with letermovir may be started on the day of transplant or on any day up to 28 days afterwards and should continue for 100 days after transplant; longer treatment may be considered in some patients at high risk for late CMV reactivation.

The list price for oral letermovir is £3,723.16 for 28×240 mg tablets (excluding VAT; British national formulary online accessed April 2019).

The intravenous formulation is not currently available in England.

The company has a commercial arrangement. This makes letermovir available to the NHS with a discount. The size of the discount is commercial in confidence. It is the company's responsibility to let relevant NHS organisations know details of the discount.