Treatment of Invasive Aspergillosis with Posaconazole in Patients Who Are Refractory to or Intolerant of Conventional Therapy: An Externally Controlled Trial

Walsh, Thomas J.; Raad, Issam; Patterson, Thomas F.; Chandrasekar, Pranatharthi H.; Donowitz, Gerald R.; Graybill, R.; Greene, Reginald E.; Hachem, Ray; Hadley, Susan; Herbrecht, Raoul; Langston, Amelia; Louie, Arnold; Ribaud, Patricia; Segal, Brahm H.; Stevens, David A.; Burik, Jo Anne H. Van; White, Charles S.; Corcoran, Gavin; Gogate, Jagadish; Krishna, Gopal; Pedicone, Lisa D.; Hardalo, Catherine; Perfect, John R.

doi:10.1086/508774

Cited by 719 publications

(609 citation statements)

References 24 publications

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“…The response rate to standard-or high-dose L-AmB, haematologica | 2010; 95(4) © F e r r a t a S t o r t i F o u n d a t i o n caspofungin or voriconazole was already reported to range from 32% to 53%. [24][25][26][27][28][29][30] The percentage of success reported in those studies is lower than that observed in our registry, which ranged from 64% to 82%. This could be explained by the very restrictive criteria for response evaluation in pivotal trials.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Ncontrasting

confidence: 61%

Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study

Pagano¹,

Caira²,

Candoni³

et al. 2009

Haematologica

301

217

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Section: © F E R R a T A S T O R T I F O U N D A T I O Ncontrasting

confidence: 61%

Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study

Pagano¹,

Caira²,

Candoni³

et al. 2009

Haematologica

301

217

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“…TDM is used to avoid treatment failure, resistance, or toxicity. The optimal plasma trough levels (with HPLC/MS) are 1-4 mg/L for itraconazole, 2-6 mg/L for voriconazole, and greater than 1 mg/L for posaconazole suspension [60][61][62]. The newer tablet or intravenous formulation of posacoanzole is more likely to achieve target plasma levels but there is limited evidence for routine TDM.…”

Section: Invasive Aspergillosismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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Purpose:To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods:A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results:Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions:Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

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“…Posaconazole, another triazole with activity against moulds, is available in oral formulation only and demonstrates moderate variability in absorption. In a salvage study for IA in patients previously treated with amphotericin products, favorable response was observed in 42% [96] and among SOT recipients specifically, 58% had successful outcomes on treatment. As with voriconazole, drug interactions can be frequently seen with posaconazole, absorption is variable, and therapeutic drug level monitoring is encouraged.…”

Section: Aspergillusmentioning

confidence: 98%

Fungal Infections in Transplant and Oncology Patients

Person

Kontoyiannis

Alexander

2011

Hematology/Oncology Clinics of North America

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Treatment of Invasive Aspergillosis with Posaconazole in Patients Who Are Refractory to or Intolerant of Conventional Therapy: An Externally Controlled Trial

Abstract: Although the study predates extensive use of echinocandins and voriconazole, these findings demonstrate that posaconazole is an alternative to salvage therapy for patients with invasive aspergillosis who are refractory to or intolerant of previous antifungal therapy.

Cited by 719 publications

References 24 publications

Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study

Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Fungal Infections in Transplant and Oncology Patients

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