Maribavir in the Treatment of Cytomegalovirus Infections that are Resistant and/or Refractory in Transplant Recipients

Objectives: This scoping review aims to gather data and map the available evidence on the efficacy and safety of maribavir (MBV ) in transplant patients with resistant and/or refractory CMV infection. Methods: This is a scoping review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The databases searched were MEDLINE, Scopus, Embase, Web of Science, and LILACS. The search used the keywords “Maribavir,” “Cytomegalovirus,” “Resistance,” and “Transplantation,” along with their synonyms and appropriate Boolean operators. Results: A total of 640 articles were retrieved in the literature search, of which 11 were included in the review. Phase 3 clinical trials showed that MBV is more effective and safer than conventional antivirals, with higher rates of viral clearance and a lower incidence of toxicities such as nephrotoxicity and myelotoxicity. Virological response rates to MBV ranged from 21% to 90%, with greater efficacy observed at week 8 compared to conventional therapies. Recurrences occurred in 20.8% to 40% of cases, mainly associated with high initial viral load. Conclusion: MBV stands out as an effective therapeutic option with a more favorable safety profile. Despite its demonstrated benefits, the emergence of resistance and viral recurrences remains an ongoing challenge. Further studies are needed to assess its impact on long-term clinical outcomes and to optimize management strategies, especially in specific patient subgroups.