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The Effect of Oral Letermovir Administration on the Pharmacokinetics of a Single Oral Dose of P‐Glycoprotein Substrate Digoxin in Healthy Volunteers

Letermovir is a human cytomegalovirus (CMV) terminase inhibitor approved in the United States, Canada, Japan, and the European Union for prophylaxis of CMV infection and disease in CMV‐seropositive, allogeneic, hematopoietic stem‐cell transplant recipients. In vitro, letermovir is a substrate and potential modulator of P‐glycoprotein. The potential of letermovir to alter the pharmacokinetics of digoxin (a P‐glycoprotein substrate) upon coadministration in healthy subjects was therefore investigated in a phase 1 trial (EudraCT: 2011‐004516‐39). Oral letermovir 240 mg was administered twice daily for 12 days with a single oral digoxin 0.5‐mg dose on day 7; after a washout period, oral digoxin 0.5 mg was administered on day 35 (sequence 1). The period order was reversed after a 28‐day washout for sequence 2. Pharmacokinetics and safety were evaluated. The presence of steady‐state letermovir reduced digoxin area under the plasma concentration–time curve from administration until last quantifiable measurement by 12% and maximum plasma concentration by 22% compared with digoxin alone; digoxin half‐life and elimination rate remained similar in both conditions. The between‐subject variability of digoxin maximum plasma concentration was higher with letermovir than without (42% vs 31%) and similar for digoxin area under the plasma concentration–time curve in both periods. No specific safety or tolerability concerns were identified. Overall, letermovir had no clinically relevant effect on concomitant administration with digoxin.