Short Versus Long Maribavir Treatment Duration for Cytomegalovirus Infection in Solid Organ Transplant Recipients: A Real‐World Cohort Study

ABSTRACT

Maribavir (MBV) is an oral antiviral approved for refractory or resistant CMV, with an 8‐week regimen used in the pivotal clinical trial. We compared outcomes of longer versus shorter MBV courses in solid organ transplant (SOT) recipients. We conducted a multicenter retrospective cohort study of all adult SOT recipients from three centers in Catalonia, Spain, treated with MBV through November 30, 2024. Patients were followed up for 3 months and categorized as receiving ≥ 42 days (long‐duration group, LDG) or < 42 days (short‐duration group, SDG). Primary outcomes were CMV clearance and recurrence. Sixty‐one SOT recipients received MBV (29 in LDG; 32 in SDG). Median treatment duration was 64 versus 24 days ( p  < 0.001). LDG patients had higher baseline CMV load (15 000 vs. 2005 IU/mL, p  = 0.001), more high‐risk transplants (lung transplant: 8 vs. 1; CMV D + /R– mismatch: 52% vs. 28%), and more refractory/resistant infection, while intolerance was more common in SDG. CMV clearance was similar between groups (59% in LDG vs. 62% in SDG, p  = 0.481), though clearance occurred later in LDG (27 vs. 13 days, p  = 0.009). Recurrence rates were comparable (35% vs. 38%, p  = 0.966). Refractory/resistance vs intolerance as the indication for MBV was the only factor associated with recurrence (51.6% vs. 21.4%, p  = 0.017). Adverse events were generally mild (mainly dysgeusia), but four patients discontinued therapy because of this. In this real‐world cohort of SOT recipients with refractory, resistant, or valganciclovir‐intolerant CMV infection, selected patients receiving shorter MBV courses achieved viral clearance and recurrence rates comparable to the standard regimen.