Comparative clinical effectiveness of prophylactic voriconazole/posaconazole to fluconazole/itraconazole in patients with acute myeloid leukaemia /myelodysplastic syndrome undergoing cytotoxic chemotherapy over a 12-year period.
Alfred Health, Melbourne, Australia;
Post-induction aplasia for acute myeloid leukaemia (AML)/myelodysplastic syndrome (MDS) is a high-risk period for invasive fungal diseases (IFDs). The effectiveness of fluconazole, itraconazole solution, voriconazole and posaconazole prophylaxis used consecutively from December 1998-January 2010 in patients with AML/MDS undergoing remission-induction chemotherapy was retrospectively evaluated. A total of 216 consecutive patients received 573 prophylaxis courses. Breakthrough-IFD incidence in fluconazole, itraconazole, voriconazole, posaconazole recipients was 25%, 16%, 14% and 3% respectively. Voriconazole/posconazole versus fluconazole/itraconazole combined was associated with significant reductions in breakthrough-IFD incidence (20% vs 8%, p=0.011), premature discontinuations (46% vs 22% p<0.001) and empiric antifungal treatment (EAFT, 31% vs 8.5%, p<0.001). Proven/probable-IFDs were molds. Posaconazole compared to other drugs was associated with fewer courses associated with computed-tomography (CT) (43% vs 26%, p<0.001). Adoption of voriconazole/posaconazole has decreased IFD incidence, EFAT and for posaconazole, CT-scan demand, with effectiveness of posaconazole comparable to clinical trial experience.
- [PubMed – as supplied by publisher]