IDStewardship

Maribavir (Livtencity)

Maribavir photo pending

KEY POINTS

  • Maribavir (Livtencity, TAK-620) is a benzimidazole riboside with activity against cytomegalovirus (CMV)
  • Maribavir works by attaching tho the UL97 encoded serine/tyrosine kinase at the ATP binding site, thus abolishing phototransferase required for a variety of essential viral processes including DNA replication, encapsidation, and nuclear egress
    • Has a unique mechanism of action which limits cross resistance
    • Maribavir can still work against CMV that is resistant to ganciclovir, foscarnet, and/or cidofovir
    • Mutations in UL97 may lead to maribavir resistance
      • CMV DNA levels are recommended to be monitored and resistance should be checked if the patient is not responding to treatment or relapses
  • Maribavir was FDA-approved on 24 November 2021 as the first drug for treating adults and pediatric patients (12 years of age and older and weighing at least 35 kilograms) with post-transplant cytomegalovirus (CMV) infection/disease that does not respond (with or without genetic mutations that cause resistance) to available antiviral treatment for CMV.
    • Maribavir is made by Takeda Pharmaceuticals
  • Approved dosing is 400 mg (two 200 mg tablets) orally twice daily with or without food
  • Maribavir may reduce the antiviral activity of ganciclovir and valganciclovir, so coadministration is not recommended
  • Requires frequent monitoring of monitor immunosuppressant drug levels (e.g., tacrolimus, cyclosporine, sirolimus and everolimus) during and when stopping treatment
    • Maribavir may increase drug concentrations of immunosuppressant drugs that are CYP3A4 and/or P-gp substrates where minimal concentration changes may lead to serious adverse events
  • Does not exhibit myelotoxicity or nephrotoxicity that is problematic with many other CMV drugs
  • Dysgeusia (a bad taste in the mouth) and other GI side effects can be a problematic common side effect of maribavir

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