Leflunomide for cytomegalovirus: bench to bedside

Cytomegalovirus (CMV) remains a major cause of morbidity and mortality among transplant recipients, frequently engaging the clinician in a struggle to balance graft preservation with control of CMV disease. Leflunomide has been shown to have immunosuppressive activity in experimental allograft model...

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Bibliographic Details
Published in:Transplant infectious disease 2012-04, Vol.14 (2), p.111-120
Main Authors: Chacko, B., John, G.T.
Format: Article
Language:English
Subjects:
A77 1726
Antiviral activity
Antiviral agents
Antiviral Agents - therapeutic use
Bioavailability
Cytomegalovirus
Cytomegalovirus - drug effects
Cytomegalovirus Infections - drug therapy
Cytomegalovirus Infections - etiology
Data processing
DNA biosynthesis
drug resistance
Drug screening
Graft rejection
Human cytomegalovirus
Humans
Immunosuppressive agents
infection
Isoxazoles - therapeutic use
leflunomide
Morbidity
Mortality
Niches
organ transplantation
Preservation
teriflunomide
Transplantation - adverse effects
Transplants & implants
Virions
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Summary:Cytomegalovirus (CMV) remains a major cause of morbidity and mortality among transplant recipients, frequently engaging the clinician in a struggle to balance graft preservation with control of CMV disease. Leflunomide has been shown to have immunosuppressive activity in experimental allograft models together with antiviral activity inhibiting CMV both in vitro and in vivo. Data are emerging about its potential role in ganciclovir‐sensitive and ‐resistant CMV, primarily by virtue of a unique mechanism inhibiting virion assembly, as opposed to inhibition of viral DNA synthesis by current agents. This review aims to put in perspective, the knowledge acquired in the last decade or so on leflunomide for CMV. Evidence suggests that it might have activity against human CMV with good oral bioavailability and, more importantly in the resource‐poor setting, is economical. Although the data presented here are not from randomized trials, several relevant observations have been made that could influence future, more structured assessments of the drug. An immune suppressive compound with antiviral features and experimental activity in chronic rejection is an attractive combination for organ transplantation, and it appears that leflunomide may just fit that niche.
ISSN:1398-2273
1399-3062
DOI:10.1111/j.1399-3062.2011.00682.x