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J Antimicrob Chemother. 2019 Aug 8. pii: dkz344. doi: 10.1093/jac/dkz344. [Epub ahead of print]

Matched-paired analysis of patients treated for invasive mucormycosis: standard treatment versus posaconazole new formulations (MoveOn).

Author information

1
University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Cologne, Germany.
2
Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
3
Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, Inserm, UMR-S1113/IRFAC, Strasbourg, France.
4
Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, Saint Petersburg, Russia.
5
Department of Internal Medicine-Hematology and Oncology, Masaryk University, Brno, Czech Republic.
6
University Hospital Brno, Brno, Czech Republic.
7
Clinical Microbiology and Parasitology Department, University Hospital La Paz, Madrid, Spain.
8
Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia.
9
School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia.
10
Center of Microbiological Research of Cesar (CIMCE), Rosario Pumarejo de López Hospital, Laura Daniela Clinic, Médicos Clinic LTDA, Valledupar, Colombia.
11
Parasitology, Mycology and Tropical Medicine Service, University Hospital of Tours, Tours, France.
12
Inserm U1100, Tours University, Tours, France.
13
Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia.
14
Service of Infectious Diseases, Clínic Hospital, University of Barcelona, Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain.
15
Division of Infectious Diseases, University of California San Diego, San Diego, CA, USA.
16
Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
17
Department of Medicine, San Diego Veterans Affairs Medical Center San Diego, CA, USA.
18
Division of Infectious Diseases, Departments of Medicine, Microbiology and Immunology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
19
Department of Clinical Microbiology, Mycology and Antibiotic Therapy, National Research Center for Hematology, Moscow, Russia.
20
Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany.
21
Section of Pulmonology and Critical Care, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
22
Department of Internal Medicine III, University of Munich, Munich, Germany.
23
Department for Hematology, Oncology and Tumorimmunology, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany.
24
Department of Haematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
25
Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
26
University of Cologne, Institute for Medical Microbiology, Immunology and Hygiene, Cologne, Germany.
27
Wisplinghoff Laboratories, Cologne, Germany.
28
Institute for Virology and Clinical Microbiology, Witten/Herdecke University, Witten, Germany.
29
German Centre for Infection Research (DZIF), partner site Bonn - Cologne, Cologne, Germany.
30
Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany.
31
Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
32
Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
33
Department of Internal Medicine, Infectious Diseases, Goethe University, Frankfurt, Frankfurt am Main, Germany.

Abstract

BACKGROUND:

First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability.

OBJECTIVES:

Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment.

METHODS:

We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction).

RESULTS:

Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp].

CONCLUSIONS:

Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.

PMID:
31393591
DOI:
10.1093/jac/dkz344

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