Tolerability of isavuconazole after posaconazole toxicity in leukemia patients.
Mycoses. 2018 Sep 19;:
Authors: DiPippo AJ, Rausch CR, Kontoyiannis DP
BACKGROUND: Posaconazole (PCZ) is widely used for prophylaxis or treatment of invasive fungal infections (IFIs) in leukemia patients. However, issues with PCZ tolerability can result in treatment interruption. Isavuconazole (ISA) has a similar broad spectrum of activity to PCZ, however real-world data regarding the tolerability of ISA after PCZ toxicity are lacking.
OBJECTIVES: To describe the tolerability of ISA after PCZ toxicity in leukemia patients.
PATIENTS/METHODS: We retrospectively assessed tolerability of ISA after PCZ toxicity in adult leukemia patients (March 2015 to November 2017). We included all patients who received > 7 days of ISA within 48 hours of PCZ discontinuation. Laboratory markers for liver toxicity were collected at three time points: prior to PCZ, at switch to ISA, and after ISA therapy.
RESULTS: We identified 23 such patients. Increased liver function tests (LFTs) were noted in 20 patients on PCZ, while 3 patients had Grade 3/4 QTc prolongation. No patient discontinued subsequent ISA due to toxicity. Grade 3/4 elevations in LFTs were decreased after changing to ISA (30% after PCZ vs. 5% after ISA). No patient had significant QTc prolongation after switching to ISA.
CONCLUSIONS: ISA was well-tolerated in patients discontinuing PCZ due to toxicity, with no patient discontinuing ISA due to toxicity. This article is protected by copyright. All rights reserved.
PMID: 30230043 [PubMed - as supplied by publisher]