{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T10:16:10Z","timestamp":1766571370394,"version":"3.48.0"},"reference-count":15,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cytomegalovirus (CMV) is a major opportunistic infection in solid organ transplant (SOT) recipients. Although valganciclovir is first\u2010line for CMV treatment, its use may be limited by resistance and myelotoxicity. Letermovir (LET) and maribavir (MBV) are increasingly used as alternative therapies, though real\u2010world outcomes remain incompletely defined. This study evaluated real\u2010world outcomes of LET and MBV in SOT recipients for whom standard CMV therapy was inadequate or not feasible. Viral clearance, breakthrough infection, refractory infection, and resistance emergence were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort analysis of adult SOT patients receiving LET (2018\u20132025) and\/or MBV (2019\u20132025) at two transplant centers. Primary outcomes included CMV breakthrough (\u2265\u2009500\u2009IU\/mL) during LET prophylaxis and CMV clearance (&lt;\u2009200\u2009IU\/mL) at the end of MBV treatment. Secondary outcomes included resistant, refractory, and recurrent CMV infection within 3\u2009months post\u2010therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 47 LET courses (41 patients), breakthrough CMV occurred in 14\/32 (44%) secondary prophylaxis (SP) courses (median viral load [VL]: 1037\u2009IU\/mL, interquartile range [IQR] 673\u20133427) but in none of the 15 primary prophylaxis (PP) courses. No resistance to LET was detected during or after prophylaxis. MBV was administered in 21 courses (17 patients); MBV\u2010refractory\/resistant (R\/R) infection occurred in 8 courses (38%), and 11 (52%) courses achieved CMV clearance. Within 3\u2009months post\u2010MBV, 14 (67%) courses had CMV VL \u2265\u20091000\u2009IU\/mL, and two (10%) courses experienced recurrence. MBV resistance emerged in 6\/17 (35%) patients during or after treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LET was effective for PP but associated with frequent breakthroughs in SP patients. MBV was limited by incomplete viral suppression and emergent resistance. These findings highlight the variable effectiveness of LET and MBV in clinical practice and support the need for further research to define optimal antiviral use in SP and refractory CMV treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70086","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T10:14:36Z","timestamp":1766571276000},"page":"815-824","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010World Use of Letermovir and Maribavir for\n                    <scp>CMV<\/scp>\n                    Prophylaxis and Treatment in Solid Organ Transplant Recipients: Clinical Outcomes and Resistance Patterns From a Dual\u2010Center Cohort"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2258-0837","authenticated-orcid":false,"given":"Man Ting","family":"Xu","sequence":"first","affiliation":[{"name":"University of British Columbia  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alissa","family":"Wright","sequence":"additional","affiliation":[{"name":"Vancouver Costal Health  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0158-2324","authenticated-orcid":false,"given":"Allison","family":"Mah","sequence":"additional","affiliation":[{"name":"Vancouver Costal Health  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4158-6955","authenticated-orcid":false,"given":"Nancy","family":"Matic","sequence":"additional","affiliation":[{"name":"University of British Columbia  Vancouver Canada"},{"name":"Providence Health Care  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9320-4499","authenticated-orcid":false,"given":"Christopher","family":"Lowe","sequence":"additional","affiliation":[{"name":"University of British Columbia  Vancouver Canada"},{"name":"Providence Health Care  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Casara","family":"Hong","sequence":"additional","affiliation":[{"name":"Providence Health Care  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1725-1407","authenticated-orcid":false,"given":"Sara","family":"Belga","sequence":"additional","affiliation":[{"name":"University of British Columbia  Vancouver Canada"},{"name":"Vancouver Costal Health  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6477-4083","authenticated-orcid":false,"given":"Wan\u2010Yun Polinna","family":"Tsai","sequence":"additional","affiliation":[{"name":"University of British Columbia  Vancouver Canada"},{"name":"BC Transplant  Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","DOI":"10.3389\/ti.2023.11785","article-title":"New Treatment Options for Refractory\/Resistant CMV Infection","volume":"36","author":"Walti C. S.","year":"2023","journal-title":"Transplant International"},{"issue":"3","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","DOI":"10.1111\/tid.13515","article-title":"Emergence of Letermovir Resistance in Solid Organ Transplant Recipients With Ganciclovir Resistant Cytomegalovirus Infection: A Case Series and Review of the Literature","volume":"23","author":"Hofmann E.","year":"2021","journal-title":"Transplant Infectious Disease"},{"issue":"1","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1001\/jama.2023.9106","article-title":"Letermovir vs Valganciclovir for Prophylaxis of Cytomegalovirus in High\u2010Risk Kidney Transplant Recipients: A Randomized Clinical Trial","volume":"330","author":"Limaye A. P.","year":"2023","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_11_5_1","volume-title":"Criteria for Formulary Consideration of Letermovir (Prevymis)","author":"Nebraska Medicine Pharmacy & Therapeutics Committee","year":"2021"},{"issue":"4","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/cid\/ciab988","article-title":"Maribavir for Refractory Cytomegalovirus Infections With or Without Resistance Post\u2010Transplant: Results From a Phase 3 Randomized Clinical Trial","volume":"75","author":"Avery R. K.","year":"2022","journal-title":"Clinical Infectious Diseases"},{"issue":"4","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/infdis\/jiaa462","article-title":"Drug Resistance Mutations and Associated Phenotypes Detected in Clinical Trials of Maribavir for Treatment of Cytomegalovirus Infection","volume":"226","author":"Chou S.","year":"2022","journal-title":"Journal of Infectious Diseases"},{"issue":"7","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofae335","article-title":"Real\u2010World Experience With Maribavir for Treatment of Cytomegalovirus Infection in High\u2010Risk Solid Organ Transplant Recipients","volume":"11","author":"Ni B.","year":"2024","journal-title":"Open Forum Infectious Diseases"},{"issue":"12","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","DOI":"10.3390\/v16121889","article-title":"Real\u2010World Comparison of Maribavir to Foscarnet for the Treatment of Cytomegalovirus in Solid Organ and Hematopoietic Stem Cell Transplant Recipients","volume":"16","author":"Ogawa L.","year":"2024","journal-title":"Viruses"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.antiviral.2021.105123","article-title":"Next\u2010Generation Sequencing for Cytomegalovirus Antiviral Resistance Genotyping in a Clinical Virology Laboratory","volume":"192","author":"Chorlton S. D.","year":"2021","journal-title":"Antiviral Research"},{"issue":"7","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1097\/TP.0000000000005374","article-title":"The Fourth International Consensus Guidelines on the Management of Cytomegalovirus in Solid Organ Transplantation","volume":"109","author":"Kotton C. N.","year":"2025","journal-title":"Transplantation"},{"issue":"4","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","DOI":"10.1111\/tid.13570","article-title":"Letermovir Prophylaxis in Solid Organ Transplant\u2014Assessing CMV Breakthrough and Tacrolimus Drug Interaction","volume":"23","author":"Winstead R. J.","year":"2021","journal-title":"Transplant Infectious Disease"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"3987","DOI":"10.2147\/DDDT.S265644","article-title":"Current Perspectives on Letermovir and Maribavir for the Management of Cytomegalovirus Infection in Solid Organ Transplant Recipients","volume":"18","author":"Razonable R. R.","year":"2024","journal-title":"Drug Design, Development and Therapy"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1016\/j.cmi.2023.03.020","article-title":"Oral Antiviral Drugs for Treatment of Cytomegalovirus in Transplant Recipients","volume":"29","author":"Razonable R. R.","year":"2023","journal-title":"Clinical Microbiology and Infection"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1080\/14787210.2024.2399647","article-title":"Management of Resistant and Refractory Cytomegalovirus Infections After Transplantation","volume":"22","author":"Pham J. H.","year":"2024","journal-title":"Expert Review of Anti\u2010Infective Therapy"},{"issue":"7","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1177\/1060028018760578","article-title":"Demonstration of Resistant or Wild\u2010Type Virus in Recurrent Viremia After Ganciclovir\u2010Resistant Cytomegaloviral Infection","volume":"52","author":"Jorgenson M. R.","year":"2018","journal-title":"Annals of Pharmacotherapy"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.70086","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T10:14:45Z","timestamp":1766571285000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.70086"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":15,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/phar.70086"],"URL":"https:\/\/doi.org\/10.1002\/phar.70086","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-05-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}