Clinical effectiveness of posaconazole versus fluconazole as antifungal prophylaxis in hematology-oncology patients: a retrospective cohort study
Journal
Cancer medicine
Journal Volume
3
Journal Issue
3
Pages
667-673
Date Issued
2014
Author(s)
Abstract
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. ? 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Subjects
Acute myeloid leukemia; fluconazole; fungal infections; myelodysplastic syndrome; posaconazole; prophylaxis
SDGs
Other Subjects
fluconazole; posaconazole; triazole derivative; adult; aged; cohort analysis; complication; controlled study; female; Hematologic Neoplasms; human; Kaplan Meier method; male; middle aged; Mycoses; pathology; randomized controlled trial; retrospective study; treatment outcome; United States; very elderly; Adult; Aged; Aged, 80 and over; Cohort Studies; Female; Fluconazole; Hematologic Neoplasms; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mycoses; Retrospective Studies; Treatment Outcome; Triazoles; United States
Type
journal article