{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:00:37Z","timestamp":1792036837281,"version":"4.4.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T00:00:00Z","timestamp":1726790400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Takeda Development Center Americas, Inc"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01-AI116635"],"award-info":[{"award-number":["R01-AI116635"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018390","name":"US","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018390","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000938","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000938","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30 CA008748"],"award-info":[{"award-number":["P30 CA008748"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Among 547 patients receiving maribavir or valganciclovir for first-episode cytomegalovirus infection after hematopoietic cell transplant, the treatment response rate was 69.6% and 77.4% respectively. Development of maribavir and ganciclovir resistance was compared after receiving either drug.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Viral mutations conferring drug resistance were analyzed in plasma DNA extracts at baseline and posttreatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Prior antiviral drug exposure was limited, with only 2 instances of baseline drug resistance detected. An equal number (n = 241) received valganciclovir or maribavir for at least 21 days (median, 55\u201356 days). Among them, drug resistance mutations were detected in 24 (10%) maribavir recipients at 35\u2013125 days (median, 56 days) after starting therapy, including in 12 of 14 who experienced a viral load rebound while on therapy. Ganciclovir resistance mutations developed in 6 (2.5%) valganciclovir recipients at 66\u2013110 days (median, 90 days). One maribavir recipient developed a novel UL97 gene mutation (P-loop substitution G343A) that conferred strong maribavir and ganciclovir resistance in vitro. Viral clearance was confirmed in 17 (74%) of 23 patients with emergent maribavir resistance after retreatment with an alternative CMV antiviral drug.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After 3\u20138 weeks of therapy, maribavir resistance emerged earlier and more frequently than ganciclovir resistance but was usually treatable using alternative therapy.<\/jats:p>\n                    <jats:p>Clinical Trials Registration. NCT02927067 (AURORA).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiae469","type":"journal-article","created":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T15:21:06Z","timestamp":1726672866000},"page":"e470-e477","source":"Crossref","is-referenced-by-count":36,"title":["Comparative Emergence of Maribavir and Ganciclovir Resistance in a Randomized Phase 3 Clinical Trial for Treatment of Cytomegalovirus Infection"],"prefix":"10.1093","volume":"231","author":[{"given":"Sunwen","family":"Chou","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Oregon Health and Science University , Portland, Oregon, USA"},{"name":"Research and Development Service, Veterans Affairs Portland Health Care System , Portland, Oregon ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew J","family":"Winston","sequence":"additional","affiliation":[{"name":"Los Angeles Medical Center, University of California , Los Angeles, California ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7692-3619","authenticated-orcid":false,"given":"Robin K","family":"Avery","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Johns Hopkins University , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Cordonnier","sequence":"additional","affiliation":[{"name":"Haematology Department, Henri Mondor H\u00f4pital, Assistance Publique-Hopitaux de Paris, and Universit\u00e9 Paris-Est-Cr\u00e9teil , Cr\u00e9teil ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael F","family":"Duarte","sequence":"additional","affiliation":[{"name":"Department of Haematology, Hospital Universitario Puerta de Hierro Majadahonda , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shariq","family":"Haider","sequence":"additional","affiliation":[{"name":"Juravinski Hospital and Cancer Center, Hamilton Health Sciences , Hamilton, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Maertens","sequence":"additional","affiliation":[{"name":"Haematology Department, University Hospitals Leuven, Katholieke Universiteit Leuven , Leuven ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl S","family":"Peggs","sequence":"additional","affiliation":[{"name":"Department of Haematology, University College London Hospitals NHS Foundation Trust , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Solano","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Cl\u00ednico Universitario, University of Valencia , Valencia ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4182-341X","authenticated-orcid":false,"given":"Jo-Anne H","family":"Young","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease and International Medicine, University of Minnesota , Minneapolis, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Gu","sequence":"additional","affiliation":[{"name":"Takeda Development Center Americas, Inc , Cambridge, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ginger","family":"Pocock","sequence":"additional","affiliation":[{"name":"Takeda Development Center Americas, Inc , Cambridge, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genovefa A","family":"Papanicolaou","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,9,20]]},"reference":[{"key":"2025031709181299900_jiae469-B1","doi-asserted-by":"crossref","first-page":"e260","DOI":"10.1016\/S1473-3099(19)30107-0","article-title":"Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European conference on infections in leukaemia (ECIL 7)","volume":"19","author":"Ljungman","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"2025031709181299900_jiae469-B2","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1056\/NEJMoa1706640","article-title":"Letermovir prophylaxis for cytomegalovirus in hematopoietic-cell transplantation","volume":"377","author":"Marty","year":"2017","journal-title":"N Engl J 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letermovir resistance","volume":"59","author":"Chou","year":"2015","journal-title":"Antimicrob Agents Chemother"},{"key":"2025031709181299900_jiae469-B6","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1093\/infdis\/jiz577","article-title":"Letermovir resistance analysis in a clinical trial of cytomegalovirus prophylaxis for hematopoietic stem cell transplant recipients","volume":"221","author":"Douglas","year":"2020","journal-title":"J Infect Dis"},{"key":"2025031709181299900_jiae469-B7","doi-asserted-by":"crossref","first-page":"e02337-18","DOI":"10.1128\/AAC.02337-18","article-title":"Use of letermovir as salvage therapy for drug-resistant cytomegalovirus retinitis","volume":"63","author":"Turner","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"2025031709181299900_jiae469-B8","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1093\/infdis\/jiad293","article-title":"Drug resistance assessed in a phase 3 clinical trial of maribavir therapy for refractory or resistant cytomegalovirus infection in transplant recipients","volume":"229","author":"Chou","year":"2024","journal-title":"J Infect Dis"},{"key":"2025031709181299900_jiae469-B9","doi-asserted-by":"crossref","first-page":"105139","DOI":"10.1016\/j.antiviral.2021.105139","article-title":"Ganciclovir and maribavir susceptibility phenotypes of cytomegalovirus UL97 ATP binding region mutations detected by expanded genotypic testing","volume":"193","author":"Chou","year":"2021","journal-title":"Antiviral Res"},{"key":"2025031709181299900_jiae469-B10","doi-asserted-by":"crossref","first-page":"105623","DOI":"10.1016\/j.antiviral.2023.105623","article-title":"Prevalence of cytomegalovirus antiviral drug resistance in transplant recipients","volume":"215","author":"Kleiboeker","year":"2023","journal-title":"Antiviral 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200 days of valganciclovir prophylaxis","volume":"53","author":"Boivin","year":"2012","journal-title":"J Clin Virol"},{"key":"2025031709181299900_jiae469-B17","doi-asserted-by":"crossref","first-page":"104711","DOI":"10.1016\/j.antiviral.2020.104711","article-title":"Advances in the genotypic diagnosis of cytomegalovirus antiviral drug resistance","volume":"176","author":"Chou","year":"2020","journal-title":"Antiviral Res"},{"key":"2025031709181299900_jiae469-B18","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.antiviral.2018.07.013","article-title":"Antiviral activity of maribavir in combination with other drugs active against human cytomegalovirus","volume":"157","author":"Chou","year":"2018","journal-title":"Antiviral Res"}],"container-title":["The Journal of Infectious 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