Managing Refractory Cytomegalovirus Post-Solid Organ Transplant

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Managing Refractory Cytomegalovirus Post-Solid Organ Transplant



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Tune in to hear an expert discussion on the role of a therapy in the management of cytomegalovirus after solid organ transplant.

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  • Overview

    Nearly 43,000 solid organ transplants (SOTs) were performed in the United States in 2022 alone,1 but patients can develop post-transplant cytomegalovirus (CMV), which is a leading cause of morbidity and mortality after SOT.2,3 Based on data from the SOLSTICE trial, the treatment option LIVTENCITY® (maribavir) may be used to help patients with post-transplant refractory CMV. Learn more about LIVTENCITY through the lens of a hypothetical patient case with Dr. Jennifer Caudle and Dr. Suphamai Bunnapradist, Professor of Medicine in the Division of Nephrology at the UCLA Medical Center.


    LIVTENCITY is indicated for the treatment of adults and pediatric patients (12 years of age and older and weighing at least 35 kg) with post-transplant cytomegalovirus (CMV) infection/disease that is refractory to treatment (with or without genotypic resistance) with  ganciclovir, valganciclovir, cidofovir or foscarnet.


    Risk of Reduced Antiviral Activity When Co-administered with Ganciclovir and Valganciclovir
    LIVTENCITY may antagonize the antiviral activity of ganciclovir and valganciclovir by inhibiting human CMV pUL97 kinase, which is required for activation/phosphorylation of ganciclovir and valganciclovir. Coadministration of LIVTENCITY with ganciclovir or valganciclovir is not recommended.

    Virologic Failure During Treatment and Relapse Post-Treatment
    Virologic failure due to resistance can occur during and after treatment with LIVTENCITY. Virologic relapse during the posttreatment period usually occurred within 4-8 weeks after treatment discontinuation. Some maribavir pUL97 resistance-associated substitutions confer cross-resistance to ganciclovir and valganciclovir. Monitor CMV DNA levels and check for maribavir resistance if the patient is not responding to treatment or relapses.

    Risk of Adverse Reactions or Loss of Virologic Response Due to Drug Interactions.

    • The concomitant use of LIVTENCITY and certain drugs may result in potentially significant drug interactions, some of which may lead to reduced therapeutic effect of LIVTENCITY or adverse reactions of concomitant drugs. Consider the potential for drug interactions prior to and during LIVTENCITY therapy; review concomitant medications during LIVTENCITY therapy and monitor for adverse reactions. Refer to the full prescribing information of LIVTENCITY for important drug interactions.
    • Maribavir is primarily metabolized by CYP3A4. Drugs that are strong inducers of CYP3A4 are expected to decrease maribavir plasma concentrations and may result in reduced virologic response; therefore, coadministration of LIVTENCITY with these drugs is not recommended, except for selected anticonvulsants.

    Use with Immunosuppressant Drugs
    LIVTENCITY has the potential to increase the drug concentrations of immunosuppressant drugs that are CYP3A and/or P-gp substrates where minimal concentration changes may lead to serious adverse events (including tacrolimus, cyclosporine, sirolimus and everolimus). Frequently monitor immunosuppressant drug levels throughout treatment with LIVTENCITY, especially following initiation and after discontinuation of LIVTENCITY and adjust immunosuppressant dose, as needed.

    Adverse Reactions
    The most common adverse events (all grades, >10 percent) in subjects treated with LIVTENCITY were taste disturbance, nausea, diarrhea, vomiting, and fatigue.

    Please click for Full Prescribing Information.

  • References:

    1. United Network for Organ Sharing. 2022 organ transplants again set annual records. Accessed March 28, 2023.
    2. Razonable  RR, Humar A; AST Infectious Diseases Community of Practice. Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013;13 Suppl 4:93-106. doi:10.1111/ajt.12103
    3. Crough T, Khanna R. Immunobiology of human cytomegalovirus: from bench to bedside. Clin Microbiol Rev. 2009;22(1):76-98. doi:10.1128/CMR.00034-08

    ©2024 Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Avenue, Lexington, MA 02421. 1-877-TAKEDA-7 (1-877-825-3327). All rights reserved. TAKEDA® and the TAKEDA Logo® are registered trademarks of Takeda Pharmaceutical Company Limited. LIVTENCITY® and the LIVTENCITY Logo® are registered trademarks of Takeda Pharmaceuticals International AG.
    US-MAR-0642v1.0 02/24 

Schedule22 May 2024