What is the role of maribavir in the treatment of cytomegalovirus (CMV)?

Updated: Jul 07, 2021
  • Author: Ricardo Cedeno-Mendoza, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Maribavir has significant activity against both human cytomegalovirus (CMV) and Epstein-Barr virus, but not other herpesviruses.

Maribavir is a benzimidazole nucleoside and prevents viral DNA synthesis, as well as capsid nuclear egress.

Unlike ganciclovir, which requires phosphorylation by UL 97 kinase to become an active inhibitor of DNA polymerase, maribavir directly inhibits UL 97 kinase.

Maribavir's bioavailability is greater than that of oral ganciclovir, but less than that of valganciclovir.

It may be useful for CMV resistant to ganciclovir, foscarnet, or cidofovir; however, the optimal dose, treatment duration, and use in combination versus monotherapy are currently undefined. [73] In a study of 6 patients treated with maribavir after failing to respond to other therapies and/or with known ganciclovir-resistant CMV, 4 patients achieved undetectable viral loads. [73] No significant adverse effects attributable to MBV were observed.

No efficacy was demonstrated in a phase 3, double-blind, placebo-controlled, randomized trial of 681 allogeneic stem cell transplant recipients who received maribavir to prevent CMV disease. [74]

Maribavir differs from current CMV antiviral agents in its adverse event profile. It is not associated with nephrotoxicity or hematologic toxicity, but has been associated with taste disturbances. [75]


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