Letermovir associated hepatic transaminitis: A case report.

Letermovir is an antiviral agent recently approved by the Food and Drug Administration for prophylaxis of cytomegalovirus infection in adult patients that are cytomegalovirus-seropositive recipients of an allogeneic hematopoietic stem cell transplant. Liver toxicity was not observed in the clinical trials that led to its approval. This report highlights a case of letermovir associated transaminitis with successful rechallenge through peak and recovery of the hepatic serum enzymes. Because there is currently no published evidence to support the adverse event, the temporal relationship and response to rechallenge that was observed is essential to establishing the probable causality in this case.

Midostaurin administration in two hemodialysis patients.

Midostaurin is a multitargeted tyrosine kinase inhibitor approved by the Food and Drug Administration for FMS-related tyrosine kinase 3-positive acute myeloid leukemia in combination with standard daunorubicin and cytarabine induction and high-dose cytarabine consolidation. The pharmacokinetics of midostaurin in the setting of severe renal impairment (creatinine clearance [CrCl] 15-29 mL/min utilizing Cockcroft-Gault method) and end-stage renal disease are unknown. Midostaurin is primarily metabolized by the liver through the CYP3A4 enzyme with fecal excretion accounting for 95% of the dose (4% recovered as unchanged drug). Only 5% of the parent drug is found in the urine. This is the first case report documenting the administration of midostaurin in two patients with end-stage renal disease on HD. Given the limited excretion of both active and inactive metabolites of midostaurin in the urine, one does not expect an increase in toxicity related to impaired drug excretion. Although this report describes the likely successful utilization of midostaurin, caution should be exercised when administering in patient populations with end organ disease. Medical history, concomitant comorbidities, and goals of therapy should be taken into account.