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

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.