Itraconazole vs. posaconazole for antifungal prophylaxis in patients with acute myeloid leukemia undergoing intensive chemotherapy: A retrospective study |
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| Affiliation: | 1. Aix-Marseille Université, IRD, APHM, MEPHI, IHU Méditerranée Infection, Marseille, France;2. Aix-Marseille Université, IRD, SSA, APHM, VITROME, IHU Méditerranée Infection, Marseille, France;3. Département de cardiologie, Hôpital de la Timone, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France;4. Laboratoire d''hématologie, Hôpital de la Timone, APHM, boulevard Jean Moulin, 13005 Marseille, France;1. Clinical Microbiology Laboratory, Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois;2. Department of Pathology, The University of Chicago Pritzker School of Medicine, Chicago, Illinois;3. The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA;4. Sequencing Core, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois;5. Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA;6. Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA;7. Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA;1. Department of Physical Chemistry, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland;2. Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, Tx, USA;3. Saint Louis University, St Louis, Mo, USA;1. Jawaharlal Nehru University, New Delhi 110067, India;2. National Centre for Disease Control, Delhi 110054, India;3. V.M. Govt. Medical College, Solapur, Maharashtra, India;4. SVN Govt. Medical College, Yavatmal, India;5. Defence Research and Development Establishment, Gwalior, India;6. Indian Institute of Science Education and Research (IISER), Berhampur, India;1. London Research and Development Centre, Agriculture and Agri-Food Canada, London, Ontario, Canada;2. Ottawa Laboratory (Carling), Canadian Food Inspection Agency, Ottawa, Ontario, Canada;3. Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada;4. Center for Structural Genomics of Infectious Diseases;5. Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada;6. Department of Biology, University of Western Ontario, London, Ontario, Canada;1. Department of Biotechnology, Chemistry and Pharmacy, University of Siena, I-53100 Siena, Italy;2. Lead Discovery Siena s.r.l., Via Vittorio Alfieri 31, I-53019 Castelnuovo Berardenga, Italy;3. Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Dipartimento di Scienze di Laboratorio e Infettivologiche, Rome, Italy;4. Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy;5. Istituto di Anatomia Patologica, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy;6. Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands;7. Radboud University Medical Center, Nijmegen, the Netherlands;8. School of Life Sciences, Jawaharlal Nehru University, New Delhi, 110067, India;9. Amity Institute of Integrative Sciences and Health, Amity University, Gurgaon 122413, Haryana, India;10. Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, BioLife Science Building, Philadelphia, PA 19122, USA |
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| Abstract: | ObjectiveThe objective of this study was to compare itraconazole with posaconazole for antifungal prophylaxis in acute myeloid leukemia (AML) patients undergoing intensive chemotherapy.MethodsAdult patients with AML received either itraconazole or posaconazole for antifungal prophylaxis while undergoing intensive chemotherapy. The primary endpoint was incidence of prophylaxis failure (change in antifungal agent due to suspected invasive fungal infection [IFI], drug intolerance, drug interaction, or adverse event).ResultsFrom February 2016 to January 2018, 90 patients were included in the itraconazole group and 45 patients in the posaconazole group. Prophylaxis failure occurred in 88% of itraconazole recipients compared with 33% of posaconazole recipients (P<0.001). The primary reason for prophylaxis failure with itraconazole was suspected IFI (58%) whereas for posaconazole, failure predominantly related to drug interaction (60%). An antifungal regimen was continued upon discharge in 47% of itraconazole recipients compared with 9% of posaconazole recipients (P<0.001). The use of breakthrough IFI diagnostic tests was not significantly different in the two groups. A larger proportion of drug concentrations were collected in the posaconazole group.ConclusionsIn AML patients undergoing intensive chemotherapy, posaconazole was associated with significantly lower rates of prophylaxis failure and less need for continued antifungal therapy on discharge compared with itraconazole. |
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