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Efficacy and safety of intravenous voriconazole and intravenous itraconazole for antifungal prophylaxis in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome
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Efficacy and safety of intravenous voriconazole and intravenous itraconazole for antifungal prophylaxis in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome
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Efficacy and safety of intravenous voriconazole and intravenous itraconazole for antifungal prophylaxis in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome
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Journal Article
Efficacy and safety of intravenous voriconazole and intravenous itraconazole for antifungal prophylaxis in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome
2011
Overview
Purpose
To compare the efficacy and safety of voriconazole with itraconazole as prophylaxis in leukemia patients.
Methods
Open-label, randomized study. Patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome undergoing induction chemotherapy or first salvage were eligible. Patients received voriconazole (400 mg intravenous (IV) every 12 h for two doses, followed by 300 mg BID) or itraconazole (200 mg IV twice daily for 2 days, followed by 200 mg IV daily).
Results
A total of 127 patients were enrolled. Four were excluded because they did not receive study drug (
n
= 3) or received two antifungal agents during the first week on study (
n
= 1), leaving 123 patients for analysis. None of the 71 patients receiving voriconazole developed proven or probable invasive fungal infection, compared to two (4%) of the 52 patients receiving itraconazole (
P
= 0.17). Drug discontinuation because of adverse events occurred in 15 patients (21%) receiving voriconazole and six (11%) receiving itraconazole (
P
= 0.23).
Conclusions
Voriconazole is a good alternative for prophylaxis in patients with leukemia. Elevated baseline bilirubin levels were associated with a higher risk of side effects in patients receiving IV voriconazole or IV itraconazole. Monitoring of liver function and drug levels should be considered for some patients.
Publisher
Springer-Verlag,Springer,Springer Nature B.V
Subject
/ Aged
/ Antifungal Agents - adverse effects
/ Antifungal Agents - therapeutic use
/ Antineoplastic Agents - therapeutic use
/ Cancer
/ Dosage
/ Drugs
/ Efficacy
/ Female
/ Humans
/ Itraconazole - adverse effects
/ Itraconazole - therapeutic use
/ Leukemia
/ Leukemia, Myeloid, Acute - complications
/ Leukemia, Myeloid, Acute - drug therapy
/ Liver
/ Male
/ Medicine
/ Mycoses
/ Mycoses - prevention & control
/ Myelodysplastic Syndromes - complications
/ Myelodysplastic Syndromes - drug therapy
/ Nursing
/ Oncology
/ Patients
/ Pyrimidines - adverse effects
/ Pyrimidines - therapeutic use
/ Risk
/ Safety
/ Salvage
