{"doi":"10.1093/infdis/jiae469","title":"Comparative Emergence of Maribavir and Ganciclovir Resistance in a Randomized Phase 3 Clinical Trial for Treatment of Cytomegalovirus Infection","abstract":"BACKGROUND: 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. METHODS: Viral mutations conferring drug resistance were analyzed in plasma DNA extracts at baseline and posttreatment. RESULTS: 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, 55-56 days). Among them, drug resistance mutations were detected in 24 (10%) maribavir recipients at 35-125 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 66-110 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. CONCLUSIONS: After 3-8 weeks of therapy, maribavir resistance emerged earlier and more frequently than ganciclovir resistance but was usually treatable using alternative therapy. Clinical Trials Registration. NCT02927067 (AURORA).","journal":"The Journal of Infectious Diseases","year":2024,"id":422360,"datarank":0.9993293615411181,"base_score":3.332204510175204,"endowment":3.332204510175204,"self_citation_contribution":0.49983067652628066,"citation_network_contribution":0.49949868501483746,"self_endowment_contribution":0.49983067652628066,"citer_contribution":0.49949868501483746,"corpus_percentile":null,"corpus_rank":null,"citation_count":27,"citer_count":24,"citers_with_citation_signal":12,"citers_with_endowment":12,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9562,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02927067"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":276586,"name":"Drew J. Winston","orcid":null,"position":1,"is_corresponding":false},{"id":275256,"name":"Robin K. Avery","orcid":"0000-0001-7692-3619","position":2,"is_corresponding":false},{"id":1216678,"name":"Catherine Cordonnier","orcid":null,"position":3,"is_corresponding":false},{"id":854302,"name":"Rafael F. Duarte","orcid":"0000-0002-5240-9815","position":4,"is_corresponding":false},{"id":1216052,"name":"Shariq Haider","orcid":"0000-0002-3776-5926","position":5,"is_corresponding":false},{"id":658352,"name":"Johan Maertens","orcid":"0000-0003-4257-5980","position":6,"is_corresponding":false},{"id":276588,"name":"Karl S. Peggs","orcid":null,"position":7,"is_corresponding":false},{"id":1216053,"name":"Carlos Solano","orcid":"0000-0003-3702-0817","position":8,"is_corresponding":false},{"id":414028,"name":"Jo‐Anne H. Young","orcid":"0000-0003-4182-341X","position":9,"is_corresponding":false},{"id":1216679,"name":"Joan Gu","orcid":null,"position":10,"is_corresponding":false},{"id":972457,"name":"Ginger M. Pocock","orcid":null,"position":11,"is_corresponding":false},{"id":228381,"name":"Genovefa A. Papanicolaou","orcid":"0000-0002-2891-079X","position":12,"is_corresponding":false},{"id":269042,"name":"Sunwen Chou","orcid":null,"position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T01:57:46.393290Z","pmid":"39302855","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}