Primary prophylaxis of invasive fungal infections with posaconazole or itraconazole in patients with acute myeloid leukemia or high-risk myelodysplastic syndromes undergoing intensive cytotoxic chemotherapy: a real world comparison

Abstract

This is an observational-retrospective study comparing the real-world outcomes associated with posaconazole vs. itraconazole as prophylaxis treatments. Two hundred and ninety-three patient admissions attributable to 174 patients were included in the study. Patients were treated with itraconazole (n = 114 admissions; 39%) or posaconazole (n = 179; 61%). Antifungal prophylaxis failure (APF) due to treatment-related adverse events (in 34 out of 293 patient admissions; 11.6%) was more frequent in the posaconazole group (6.1% vs. 15.1%; P = 0.024). There were 9 patient admissions for episodes of APF due to probable/proven breakthrough fungal infection (primary endpoint): 6 and 3 in the itraconazole and posaconazole group, respectively (5.3% vs. 1.7%; P = 0.095). All of them were associated with invasive pulmonary aspergillosis (IPA). APF was more frequent with itraconazole (65% vs. 30%; P < 0.001), along with failure due to possible/probable/proven IPA (25% vs. 10%; P = 0.002) and overall failure by any of the three different causes of prophylaxis failure (70% vs. 38%; P < 0.001). In agreement with clinical trial data, this real-world evidence supports the use of posaconazole over itraconazole in AML or MDS patients undergoing intensive chemotherapy.

This article is protected by copyright. All rights reserved.