Effectiveness of Posaconazole Vs Fluconazole as Antifungal Prophylaxis in Hematology-Oncology Patients at Duke University Hospital (DUH) 2004-2010

Ref ID: 18746

Author:

H. C. Kung, MD – Fellow1, M. D. Johnson, PharmD, MHS – Assistant Professor of Medicine 2, R. H. Drew, PharmD, MS – Associate Professor of Medicine 2, P. Saha-Chaudhuri, PhD – Assistant Professor 3, J. R. Perfect, MD – Professor and Chair, Division of

Author address:

1Duke Clinical Res. Inst., Durham, NC, 2Duke Univ. Med. Ctr., Durham, NC, 3Duke Univ. Sch. of Med., Durham, NC.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: While a randomized controlled study demonstrated benefits of posaconazole vs azole in preventing invasive fungal disease (IFD) in patients with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS), US experience outside this clinical trial has not been published. Methods: Patients ≥ 18 years admitted to DUH 2004-2010 undergoing first induction or first re-induction chemotherapy for AML or MDS administered posaconazole or fluconazole as prophylaxis were included. Patients receiving other concomitant systemic antifungals, or diagnosed with IFD 8804; 1 month prior to initiation of chemotherapy, were excluded. The primary endpoint was possible, probable, or definite breakthrough IFD. The secondary endpoint was all-cause mortality at 100 days following chemotherapy initiation. Results: 130 patients (fluconazole, n=65; posaconazole, n=65) were included. Baseline characteristics were balanced between groups, except posaconazole recipients received re-induction 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 a multivariate logistic regression model, fluconazole prophylaxis (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.6-15.4, p=0.0053) and duration of neutropenia (per additional day, OR 1.1, CI 1.03-1.1, p=0.0005) were predictors of IFD. 100d mortality (24.6% and 21.5%, p=0.68) and overall mortality (50.8% and 50.8%, p=1.0) were similar between groups. Conclusions: The current study demonstrates superior effectiveness of posaconazole to fluconazole for the prophylaxis of IFD in AML and MDS patients. Such superiority did not translate to reductions in 100-day all-cause mortality.

Abstract Number: M-1703

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

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