Use of triazoles for the treatment of invasive aspergillosis: a three-year cohort analysis.
Mycoses. 2019 Oct 06;:
Authors: Cheng MP, Orejas JL, Arbona-Haddad E, Bold TD, Solomon IH, Chen K, Pandit A, Kusztos AE, Cummins KC, Liakos A, Marty FM, Koo S, Hammond SP
OBJECTIVES: While voriconazole is recommend as first-line therapy for patients with invasive aspergillosis (IA), isavuconazole and posaconazole are approved for the treatment and prophylaxis of IA, respectively. We evaluated patients with IA who received triazoles to address treatment preferences and clinical outcomes.
METHODS: We conducted a retrospective cohort study of adult patients with proven or probable IA per EORTC/MSG criteria who received triazole treatment between March 2015 and December 2017 at our institution. Documented changes in therapy were attributed to lack of clinical efficacy, adverse effects, or other reasons.
RESULTS: Sixty-eight patients met the study criteria (19 with proven IA and 49 with probable IA). Thirty-two patients received IA treatment with voriconazole, 28 with isavuconazole, and 8 with posaconazole. There were no significant differences in baseline characteristics among patients who initiated voriconazole or isavuconazole therapy. Antifungal changes due to concerns for lack of clinical efficacy or drug toxicity were 0% and 22% for voriconazole, respectively, compared to 18% and 4% for isavuconazole. All-cause mortality at 6 weeks (34% vs. 43%, p=0.60) and 12 weeks (41% vs. 50%, p=0.60) as well as EORTC/MSG success rates at 6 weeks (39% vs. 32%, p=0.79) and 12 weeks (52% vs. 46%, p=0.80) were similar among patients initially treated with voriconazole or isavuconazole respectively.
CONCLUSIONS: Fewer patients initially treated with isavuconazole experienced adverse events compared to voriconazole, but more patients required a change in therapy due to lack of efficacy. No difference in clinical outcomes was observed among patients treated with either isavuconazole or voriconazole.
PMID: 31587405 [PubMed – as supplied by publisher]