Factors Associated with Low Posaconazole Plasma Concentrations and Impact of Structured Patient Education

Ref ID: 19480

Author:

M Hoenigl1*, W Duettmann2, R Raggam3, F Prueller3, J Prattes1, G Theiler2, W Buzina4, K Seeber1,
B Huber-Krassnitzer2, J Wagner1, A Wölfler2, R Krause1

Author address:

1Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University
of Graz, Graz, Austria
2Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
3Clinical Institu

Full conference title:

6th Advances Against Aspergillosis 2014

Abstract:

Purpose:
The objectives of the study were to analyze factors associated with low posaconazole plasma
concentrations among patients with hematological malignancies receiving the suspension
prophylactically and to evaluate the impact of a structured patient education on low levels.
Methods:
The study was conducted from July 1st 2012 to June 1st 2013 at the Division of Hematology,
Medical University of Graz, Austria. Steady sate PPCs measured on day 7 or later in patients with
hematological malignancies and posaconazole prophylaxis were included. Concentrations above the
target of 0.5 mg/L were defined as satisfactory and those below the target as low PPCs. In patients
with low drug levels a structured personal on-site education concerning the intake of posaconazole
was performed.
Results:
258 trough PPCs were measured in 65 patients (23 GVHD phase after haematopoietic stem cell
transplantation, 42 neutropenia after induction therapy; median PPC 0.59 mg/L, IQR 0.25-0.92).
141/258 (55%) of PPCs were satisfactory, while 54 (21%) were below 0.2 mg/L. Diarrhea at the time
the PPC was obtained remained an independent predictor of low PPCs in multivariable analysis (OR
0.14; 95% CI 0.03-0.67). Higher BMI, receipt of systemic corticosteroids and T-cell suppressant
were predictors for satisfactory PPC’s. Initial steady state PPCs were sufficient in 29 (45%) and low
in 36 (55%) patients. In 28/36 patients with low PPCs a personal on site education was performed. In
12/28 (42.9%) patients the personal on-site education led to sufficient levels, while in 16 (57.1%) the
PPCs stayed below the target, although increasing from below 0.2 to above 0.3 in 6 of those patients.
Conclusion:
Low PPCs were frequently observed and diarrhea remained the strongest predictor of low PPCs in
multivariable analysis. A structured personal on site education led to sufficient levels in more than
40% of patients and may therefore be a promising tool to increase low PPCs.

Abstract Number: 8

Conference Year: 2014

Link to conference website: http://www.AAA2014.org

New link: NULL

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