Artikel
Positive impact of posaconazole prophylaxis in a real life setting
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Veröffentlicht: | 13. März 2017 |
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Gliederung
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Invasive fungal infections (IFI) are a hazard in patients with acute myeloid leukemia during induction chemotherapy. Guidelines strongly recommend posaconazole prophylaxis for patients with acute leukemia and patients with graft versus host disease. However, the oral solution of posaconazole has a low oral bioavailability and highly variable plasma concentrations. The aim of this study was to evaluate the effectiveness of posaconazole oral solution in a real life setting, since the tablet formulation was not available at that time. Furthermore, we analyzed the use of systemic antifungal and antibiotic treatment, costs of antifungal prophylaxis and therapy as well as the clinical course of the patients. Beyond that, the impact of patient education on posaconazole plasma concentration was studied. Posaconazole prophylaxis was retrospectively evaluated in 96 patients with acute myeloid leukemia/myelodysplastic syndrome receiving 154 cycles of induction chemotherapy. This study demonstrated that preemptive systemic antifungal treatment could be reduced to half (p=0.002) in case of posaconazole prophylaxis. Also, significantly less systemic antibiotic therapy was used in the prophylaxis group (p=0.03). Despite patient education, median plasma concentrations remained low (625–817 ng/mL) throughout treatment courses. Regardless of the highly variable and prevalent low plasma concentrations, posaconazole prophylaxis was associated with a significantly lower risk of proven IFIs when compared to patients without posaconazole prophylaxis.