Cytomegalovirus treatment

Khare MD and Sharland M. Cytomegalovirus treatment options in immunocompromised patients. Expert Opin Pharmacother 2001 2 1247-1257. 

Antiviral drugp interfere with viral reproduction by altering DNA synthesis. These drug are used in the treatment of herpes simplex infections of the eye, treatment in immunocompromised patients with cytomegalovirus (CMV) retinitis, and for the prevention of CMV retinitis in patients undergoing transplant. 

Chulay J, Biron K, Want L, Underwood M, Chamberlain S, Frick L, Good S, Davis M, Harvey R, Townsend L, Drach J, Koszalka G (1999) Development of novel benzimidazole riboside compounds for treatment of cytomegalovirus disease. In Mills J, Volberding P, Corey L (eds) Antiviral therapy 5 new directions for clinical applications and research. Kluwer/Plenum, NY, pp 129-134... 

Cytomegalovirus (CMV) No significant reduction of the risk of CMV disease Reduced CMV viremia on IFN-a treatment Hodson et al. 2007... 

Vitravene Study Group (2002) A randomized controlled chnical trial of intravitreous fomivirsen for treatment of newly diagnosed peripheral cytomegalovirus retinitis in patients with AIDS, Am J Ophthalmol 133 467 74... 

Currently, there is only one antisense drug on the market— Vitravene (active ingredient fomivirsen) for the treatment of cytomegalovirus (CMV)-induced retinitis (inflammation of the retina) in AIDS patients. Fomivirsen has 21 nucleotides complementary to a CMV mRNA sequence, which is necessary for the production of infectious virus. Two examples of experimental antisense drugs are provided in Exhibit 3.15, while Table 3.1 lists other antisense drugs in clinical phase. 

In a study reported in 2001, Curran described research designed to synthesize a library of analogs of a natural product called map-picine. A ketone derivative of mappicine had been shown to be effective in the treatment of the herpes virus and cytomegalovirus. Curran s research team was interested in determining whether there were analogs of mappicine that also display antiviral action. 

Ganciclovir (structure on p. 285) is given by infusion in the treatment of severe infections with cytomegaloviruses (also belonging to the herpes group) these do not induce thymi ne kinase, phosphorylation being initiated by a different viral enzyme. Ganciclovir is less well tolerated and, not infrequently, produces leukopenia and thrombo-penia. 

Cytomegalovirus (CMV) retinitis Treatment of CMV retinitis in patients with AIDS. Combination Combination therapy with ganciclovir for patients who have relapsed after monotherapy with either drug. 

Ganciclovir IV is indicated for use only in the treatment of cytomegalovirus (CMV) retinitis in immunocompromised patients and for the prevention of CMV disease in transplant patients at risk for CMV disease. 

Strippoli, G.F., Hodson, E.M., Jones, C. and Craig, J.C. (2006) Preemptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients. Transplantation, 81, 139-145. 

In 1996 cidofovir was approved for the treatment of AIDS-related cytomegalovirus retinitis. It is already a monophosphate and does not need activation by viral enzymes. 

A small number of biopharmaceuticals are delivered by nonparenteral means. Recombinant DNase is given by inhalation aerosol to reduce the viscosity of mucus in the lungs of patients with cystic hbrosis. A platelet-derived growth factor in the form of a gel is administered topically for wound healing. Several hormones and peptides are administered in solution by the intranasal route. A solution of an antisense drug used for the treatment of cytomegalovirus retinitis is injected directly into the eye. 

Indications Treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome... 

PFA has recently undergone clinical evaluation in humans for the treatment of recurrent genital herpes, hepatitis B viral infection, and acquired immunodeficiency syndrome (AIDS), as well as cytomegalovirus (CMV) infection of bone marrow and renal transplant patients. 

Fischler B, Casswall TH, Malmborg P, Nemeth A. Ganciclovir treatment in infants with cytomegalovirus infection and cholestasis. J Pediatr Gastroenterol Nutr 2002 34(2) 154-7. 

The first antisense drug Vitravene has now been approved for the treatment of patients with cytomegalovirus-induced... 

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