gms | German Medical Science

Frühjahrstagung der Sektion Antimykotische Chemotherapie 2017

Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG e. V.)

17. - 18.03.2017, Bonn

Positive impact of posaconazole prophylaxis in a real life setting

Meeting Abstract

  • Michele Porsche - Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
  • Florentina Kosely - Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
  • Nicolas Hohmann - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
  • Antje Blank - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
  • Werner J. Heinz - Department of Internal Medicine II, University of Wuerzburg Medical Center, Wuerzburg, Germany
  • Gerd Mikus - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
  • corresponding author Gerlinde Egerer - Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
  • Alexandra Carls - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany

Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG). Frühjahrstagung der Sektion Antimykotische Chemotherapie 2017. Bonn, 17.-18.03.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc17sac17

doi: 10.3205/17sac17, urn:nbn:de:0183-17sac178

Veröffentlicht: 13. März 2017

© 2017 Porsche et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

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.