Posaconazole prophylaxis – impact on incidence of invasive fungal disease and antifungal treatment in haematological patients

Abstract

Since two large-scale, randomised studies on posaconazole prophylaxis have demonstrated a clear benefit for patients at high risk for contracting invasive fungal disease (IFD), posaconazole prophylaxis has been adopted as standard of care for this patient collective. Several years on from implementation at our institution, we wanted to evaluate its impact on the incidence and use of empirical antifungal therapy in a real-life setting. We analysed retrospectively incidence and severity of IFD in high-risk patients with prophylaxis, using a historical cohort as comparator. A total of 200 patients had either received the extended spectrum triazole posaconazole in prophylactic dosage of 200 mg tid or empirical antifungal therapy. Disease events were analysed by application of the revised EORTC/MSG definitions for IFD. Before posaconazole prophylaxis, we recorded 57/100 cases of IFD which was reduced to 28/100 with prophylaxis. The empirical use of antifungal drugs was reduced to 41% from 91% in the non-prophylaxis cohort. Furthermore, we observed a shift in the categorisation of IFD according to EORTC/MSG criteria. Our data suggest that posaconazole was effective in reducing the rate and probability of invasive fungal disease in high-risk patients.

Efficacy of antifungal prophylaxis with oral suspension posaconazole during induction chemotherapy of acute myeloid leukemia

“…Our observation of possible IFD in 21 % of patients correlates well with recently published data (Bourdelin et al 2014;Peterson et al 2013). The detection of aspergillus antigen by serum galactomannan assay was not implemented in our routine diagnostic procedure and might result in a lower frequency of possible IFD.…”

The role of primary antifungal prophylaxis in patients with haematological malignancies

“…In the last few years, some real‐life experiences confirmed the efficacy of posaconazole prophylaxis in this clinical setting, even if they were almost all retrospective studies and with historical comparisons (Table ) .…”

“…For this reason, real-life studies may be of help in assessing whether results from randomized clinical trials can be translated into clinical practice. In the last few years, some real-life experiences confirmed the efficacy of posaconazole prophylaxis in this clinical setting, even if they were almost all retrospective studies and with historical comparisons (Table 2) [33,[57][58][59][60][61][62][63][64].…”

“…Incidence of proven/probable (according to current EORTC/MSG diagnostic criteria) invasive fungal infections in acute myeloid leukaemia after posaconazole prophylaxis: data from comparative studies [adapted from33,[56][57][58][59][60][61][62][63][64] …”

A Single Center Experience for Antifungal Prophylaxis in Patients with Acute Myelogenous Leukemia

“…However, factors such as epidemiologic features of the center, duration of neutropenia or response to the treatment for AML can influence the incidence of IFDs along with the type of the antifungal prophylaxis. Recently, a prospective observational study reported no difference in the incidence of IFDs in AML patients receiving remission-induction or consolidation therapy regarding to the type of AFP contrast to numerous studies in this field [6][7][8][9][10]. Also, a study from Turkey which included 50 patients with AML did not find any difference between posaconazole and fluconazole in terms of AFP failure [11].…”