Journal Article

Clinical effectiveness of posaconazole versus fluconazole as antifungal prophylaxis in hematology–oncology patients: a retrospective cohort study

Drew, Richard H., Perfect, John R., Johnson, Melissa D., Saha‐Chaudhuri, Paramita, Kung, Hsiang‐Chi

2014

Overview

In preventing invasive fungal disease (IFD) in patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS), clinical trials demonstrated efficacy of posaconazole over fluconazole and itraconazole. However, effectiveness of posaconazole has not been investigated in the United States in real‐world setting outside the environment of controlled clinical trial. We performed a single‐center, retrospective cohort study of 130 evaluable patients ≥18 years of age admitted to Duke University Hospital between 2004 and 2010 who received either posaconazole or fluconazole as prophylaxis during first induction or first reinduction chemotherapy for AML or MDS. The primary endpoint was possible, probable, or definite breakthrough IFD. Baseline characteristics were well balanced between groups, except that posaconazole recipients received reinduction chemotherapy and cytarabine more frequently. IFD occurred in 17/65 (27.0%) in the fluconazole group and in 6/65 (9.2%) in the posaconazole group (P = 0.012). Definite/probable IFDs occurred in 7 (10.8%) and 0 patients (0%), respectively (P = 0.0013). In multivariate analysis, fluconazole prophylaxis and duration of neutropenia were predictors of IFD. Mortality was similar between groups. This study demonstrates superior effectiveness of posaconazole over fluconazole as prophylaxis of IFD in AML and MDS patients. Such superiority did not translate to reductions in 100‐day all‐cause mortality. In adults receiving first induction or first reinduction chemotherapy for acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS), posaconazole prophylaxis was associated with significantly fewer invasive fungal infections than fluconazole prophylaxis. This study demonstrates superior effectiveness of posaconazole over fluconazole as prophylaxis of invasive fungal disease in AML and MDS patients.

• Publisher: John Wiley & Sons, Inc,BlackWell Publishing Ltd
• Subject: Acute myeloid leukemia / Adult / Aged / Aged, 80 and over / Antifungal agents / Chemotherapy / Clinical medicine / Clinical trials / Cohort analysis / Cohort Studies / Cytarabine / Disease prevention / Epidemiology / Female / Fever / Fluconazole / Fluconazole - administration & dosage / Fluconazole - adverse effects / fungal infections / Hematologic Neoplasms - complications / Hematologic Neoplasms - drug therapy / Hematologic Neoplasms - pathology / Hematology / Humans / Independent contractors / Invasiveness / Itraconazole / Kaplan-Meier Estimate / Laboratories / Leukemia / Male / Medical records / Middle Aged / Mortality / Multivariate analysis / Mycoses - complications / Mycoses - drug therapy / Mycoses - pathology / Myelodysplastic syndrome / Myelodysplastic syndromes / Myeloid leukemia / Neutropenia / Oncology / Original Research / Patients / Posaconazole / prophylaxis / Retrospective Studies / Survival analysis / Treatment Outcome / Triazoles - administration & dosage / Triazoles - adverse effects / United States