THE SUCCESSFUL USE OF MARIBAVIR FOR GANCICLOVIR RESISTANT CYTOMEGALOVIRUS DISEASE IN PERSON WITH KIDNEY FAILURE ON HAEMODIALYSIS
Dr Kanzool Hasan1, Dr Dharmenaan Palamuthusingam1,2, Dr Shain Chandler1,2, Dr Monica Ng1,2,3,4
1Kidney Health Service Metro North, Royal Brisbane and Women’s Hospital, Herston, Australia, 2Faculty of Medicine, University of Queensland, Herston, Brisbane, Australia, 3Conjoint Internal Medicine Laboratory, Pathology Queensland, Herston, Australia, 4Institute of Molecular Biosciences, St Lucia, Australia
Background: Maribavir is an oral benzimidazole riboside that inhibits cytomegalovirus viral kinase UL97 to inhibit DNA replication, encapsidation and nuclear egress. There is limited information available regarding the efficacy and safety of Maribavir in people on intermittent haemodialysis.
Case Report: A 63-year-old female with kidney failure secondary to anti-glomerular basement membrane (anti-GBM) disease was admitted to hospital due to recurrent fevers. She was on oral cyclophosphamide and prednisolone for anti-GBM disease. She was commenced on empiric broad spectrum antibiotics and cyclophosphamide was ceased. Multiple blood and urine cultures were negative. Serum cytomegalovirus DNA was detected using polymerase chain reaction (PCR) at a titre of 1.45 x 104 IU/ml. During this time, the patient developed increasing oxygen requirement prompting CT scan of her chest which demonstrated bilateral ground glass opacities and subsequent bronchoscopy washings were positive for cytomegalovirus DNA – confirming cytomegalovirus pneumonitis.
She was commenced on intravenous Ganciclovir (1.25mg/kg) following each haemodialysis session. After 2 weeks of therapy, her cytomegalovirus infection was deemed ganciclovir-resistant clinically based on uptrending serum cytomegalovirus titres (1.96 X 105 IU/mL) along with ongoing fevers and oxygen requirement. Maribavir was commenced at a dose of 400mg twice daily. Her fevers stopped within 72 hours and her oxygen requirement decreased. Her serum cytomegalovirus titre was undetectable within 3 weeks of Maribavir commencement.
Conclusion: A short course of Maribavir can be safely used for the treatment of ganciclovir-resistant CMV disease in people with kidney failure on haemodialysis. Further studies are required characterise the pharmacokinetics of maribavir in people on haemodialysis.
Biography:
Final Year Basic Physician Trainee at the Royal Brisbane Women’s Hospital