Maribavir use in practice for cytomegalovirus infection in French transplantation centers.

S Alain (1) , M Revest (2) , D Veyer (3) , Marie Essig (4) , J P Rerolles (4) , W Rawlinson (1) , C Mengelle (5) , Agnès Huynh (6) , N Kamar (7) , I Garrigue (8, 9) , H Kaminski (10) , C Segard (11) , C Presne (12) , M C Mazeron (13) , V Avettant-Fenoël (14) , Marc Lecuit (15, 16) , O Lortholary (15) , A Coaquette (17) , S Hantz (1) , M Leruez-Ville (14) , Marie-Cécile Ploy (1)

1 Service de Bactériologie, Virologie, Hygiène [CHU Limoges]
2 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
3 Laboratoire de Virologie [Rennes] = Virology [Rennes]
4 Service de Néphrologie, Dialyse, Transplantations [CHU Limoges]
5 Laboratoire Virologie [CHU Toulouse]
6 Service Hématologie - IUCT-Oncopole [CHU Toulouse]
7 Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation
8 Service de virologie et d'immunologie biologique
9 MFP - Microbiologie Fondamentale et Pathogénicité
10 Service de Néphrologie-transplantation-dialyse [Bordeaux]
11 UVCF - Unité de Virologie clinique et fondamentale
12 Service de Néphrologie - Médecine Interne
13 Laboratoire de Virologie [CHU Saint-Louis]
14 Laboratoire de Virologie [CHU Necker]
15 Centre d'infectiologie Necker-Pasteur [CHU Necker]
16 CNR-CCOMS - Centre National de Référence des Listeria-G5 Microorganismes et Barrières de l'Hôte
17 API - Agents pathogènes et inflammation - UFC (EA 4266)

Maribavir (MBV), a UL97 inhibitor, shows good oral bioavailability, low host cell toxicity, and theoretical benefits to inhibit cross-resistant viruses. We herein examined clinical and virological outcomes of 12 patients, including 3 bone marrow recipients and 9 organ recipients infected with resistant cytomegalovirus (CMV) and treated with MBV during 2011-2012. All received at least 800-mg daily doses. They had developed clinical (12/12) and/or virological (11/12) resistance to CMV infection. Based on a decrease of viral load in blood >1.5 log copies/mL half of them responded to MBV treatment. The individual changes varied from a rapid decrease in viral load (n = 4) to no response (n = 3) with some late response slowly decreasing viremia (n = 3). In 2 cases MBV was used as secondary prophylaxis. No clear parameter emerged as a clinical surrogate for nonresponse to MBV. These results contrast with the lack of efficacy in phase III trials of MBV prophylaxis among stem cell recipients, which were possibly due to low doses or inadequate timing of drug initiation in the study. Additional clinical and surrogate laboratory markers are needed to determine antiviral responses to guide MBV use. Dosage ranging studies might benefit future MBV use.

Domaines: Microbiologie et Parasitologie

S Alain, M Revest, D Veyer, Marie Essig, J P Rerolles, et al.. Maribavir use in practice for cytomegalovirus infection in French transplantation centers.. Transplantation Proceedings, 2013, 45 (4), pp.1603-1607. ⟨10.1016/j.transproceed.2013.01.082⟩. ⟨hal-01101099⟩