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Mycoses. 2019 Jun;62(6):526-533. doi: 10.1111/myc.12911. Epub 2019 Apr 3.

Posaconazole salvage therapy: The Posifi study.

Author information

1
Infectious Diseases Department, Hospital Ramón y Cajal, IRYCIS (Instituto Ramón y Cajal de Investigación Sanitaria), Universidad de Alcalá, Madrid, Spain.
2
Infectious Diseases Department, Hospital Clínic, IDIBAPS (Institut d'Investigacions biomèdiques Agust Pi i Sunyer), Universitat de Barcelona, Barcelona, Spain.
3
Infectious Diseases Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
4
IDIBELL, Universitat de Barcelona, Barcelona, Spain.
5
Pharmacology Department, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain.
6
Infectious Diseases Unit, Hospital Universitario Reina Sofia, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain.
7
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain.
8
Universidad Complutense de Madrid, Madrid, Spain.
9
Hematology Department, Hospital Ramón y Cajal, IRYCIS (Instituto Ramón y Cajal de Investigación Sanitaria), Universidad de Alcalá, Madrid, Spain.
10
Hematology Department, Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain.

Abstract

BACKGROUND:

Posaconazole (PCZ) is used mainly for the prevention of invasive fungal infection (IFI).

METHODS:

A multicentre retrospective, investigational study using a non-randomized, single-arm design carried out in six tertiary hospitals in Spain to evaluate the use of PCZ in different forms of administration in the (non-prophylactic) treatment of IFI.

RESULTS:

Over an eight-year-period, 67 patients were included in this study. PCZ was administered as salvage therapy (intolerant or refractory to a previous antifungal agent) in 65/67 (97%); of these, it was used against Aspergillosis (68.6%), Zygomycosis (13.4%), other moulds (8.9%) and yeast (10.5%). The median duration of PCZ therapy was 75 days. The oral solution was associated with low serum levels (<0.7 mg/L) in 63% of available patients. Clinical response at 3 and 12 months of PCZ therapy were for aspergillosis: 47.8% and 41.3%; for zygomycosis: 55.5% and 55.5%; and for other mycoses: 69.2% and 69.2%, respectively. Suspension by toxicity was only observed in 6% and 7.5% of patients at 3 and 12 months, respectively, mainly with grade III/IV elevations of liver function test (LFTs).

CONCLUSIONS:

Posaconazole salvage therapy, especially oral tablets, can be an effective alternative option for patients with IFI who cannot tolerate or do not respond to other antifungal therapies.

KEYWORDS:

aspergillosis; intolerant therapy; posaconazole; refractory therapy; salvage therapy; yeast; zygomycosis

PMID:
30864238
DOI:
10.1111/myc.12911
[Indexed for MEDLINE]

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