Two Cases of Maribavir Treatment of Refractory/Resistant Cytomegalovirus Infection in Solid-Organ Transplant Recipients: Time for a New Paradigm?

Refractory and resistant cytomegalovirus infections remain significant challenges in solid-organ transplant recipients. In this context, maribavir is a valuable therapeutic option for management of cytomegalovirus infection. Although the clinical efficacy and safety of maribavir are well established, the optimal approach for assessment of viremic response, which is defined as the clearance of viremia, still requires further clarification. Notably, some patients treated with maribavir do not achieve full viremia clearance, despite clinical improvement and a significant reduction in viral load. In this report, we shared our exploration of the potential for a new paradigm for management of the viremic response during maribavir therapy. Our experience suggested that the goal to achieve complete viremia clearance may not always be necessary if clinical resolution and stable viremic responses (ie, viral load <1000 IU/mL) are achieved. In such cases, discontinuation of therapy with close monitoring may be a viable option.