Clinical outcomes in patients with chronic pulmonary aspergillosis following discontinuation of therapy

Felix Bongomin 1, Chris Harris 2, David W. Denning*3

Author address: 

1 National Aspergillosis Centre; University Hospital of South Manchester; 2 University Hospital of South Manchester; National Aspergillosis Centre; 3 Wythenshaw Hospital, Southmoor Hospital; Education & Research Centre.

Abstract: 

Background: The sensitivity of the St. George’s Respiratory Questionnaire (SGRQ) score to
determine improvement or deterioration in chronic pulmonary aspergillosis (CPA) patients has been
validated. The aim of this study was to evaluate the clinical outcomes following discontinuation of
therapy in patient with CPA
Material/methods: We performed a retrospective audit. We evaluated quality of life, weight, and
Aspergillus-specific IgG to assess clinical outcome. Assessment was based on the duration the
patients were off therapy and indication for discontinuation of therapy. Kaplan-Meier survival models
were used for both survival and quality of life change over time on St. George’s Respiratory
Questionnaire (SGRQ) score (1-100, high = worse).
Results: Forty-eight (48) patients were recruited in this audit, 26 (54%) of whom were males with a
median (range) age of 63 (33-89) years. Their end of therapy SGRQ was 60.3 points and Aspergillus
IgG titre 276mg/L. Twenty–eight (58 %) had to discontinue therapy due to adverse events, 15 (31%)
due to antifungal resistance and 5 (10%) had both. Eighteen (38%) of our patients had an increase of
>4/100 unit in their SGRQ scores over the 12 months, with 7 (15%) of the patients having marked
deterioration (≥12/100 increase) indicative of relapse following discontinuation of therapy. The most
severe clinical deteriorations were seen within the first six months in 71% of the patients (p=0.048).
Nine (20%) of the 45 patients who had their oral triazoles discontinued had at least a trial of an
intravenous antifungal during the 12 months of follow-up. Four (8%) patients died within 6 months after
cessation of treatment.
Conclusions: Discontinuation of therapy is associated with reduced quality of life. Clinical
deterioration is more common within the first 6 months following discontinuation of therapy

2017

Poster: 

AttachmentSize
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abstract No: 

P1701

Full conference title: 

27th European Congress of Clinical Microbiology and Infectious Diseases (2017, Vienna)
    • ECCMID 27th (2017)