Primary prophylaxis of invasive fungal infections with posaconazole or itraconazole in patients with acute myeloid leukaemia or high-risk myelodysplastic syndromes undergoing intensive cytotoxic chemotherapy: A real-world comparison.

Authors:
Mar Tormo
Mar Tormo
Hospital Universitario La Fe
Spain
Paula Amat
Paula Amat
Hospital Clínico Universitario
Spain
David Navarro
David Navarro
Hospital Clínico Universitario
Spain
Carlos Solano
Carlos Solano
Hospital Clínico Universitario
Spain

Mycoses 2018 Mar 3;61(3):206-212. Epub 2018 Jan 3.

Hematology Service, Hospital Clínico Universitario-INCLIVA, Valencia, Spain.

This is an observational-retrospective study comparing the real-world outcomes associated with posaconazole vs itraconazole as prophylaxis treatments. Two hundred and ninety-three patient admissions attributable to 174 patients were included in the study. Patients were treated with itraconazole (n = 114 admissions; 39%) or posaconazole (n = 179; 61%). Antifungal prophylaxis failure (APF) due to treatment-related adverse events (in 34 out of 293 patient admissions; 11.6%) was more frequent in the posaconazole group (6.1% vs 15.1%; P = .024). There were 9 patient admissions for episodes of APF due to probable/proven breakthrough fungal infection (primary endpoint): 6 and 3 in the itraconazole and posaconazole group respectively (5.3% vs 1.7%; P = .095). All of them were associated with invasive pulmonary aspergillosis (IPA). APF was more frequent with itraconazole (65% vs 30%; P < .001), along with failure due to possible/probable/proven IPA (25% vs 10%; P = .002) and overall failure by any of the 3 different causes of prophylaxis failure (70% vs 38%; P < .001). In agreement with clinical trial data, this real-world evidence supports the use of posaconazole over itraconazole in AML or MDS patients undergoing intensive chemotherapy.

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http://dx.doi.org/10.1111/myc.12728DOI Listing
March 2018
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References

(Supplied by CrossRef)
Empiric antifungal therapy for the neutropenic patient
Wingard et al.
Oncology (Williston Park) 2001
Laboratory diagnosis of invasive aspergillosis
Hope et al.
Lancet Infect Dis 2005

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