Assessment of posaconazole salvage therapy in chronic pulmonary aspergillosis using predefined response criteria.

Abstract

OBJECTIVES:

Chronic pulmonary aspergillosis (CPA) is a progressive infection that destroys lung tissue in non-immunocompromised patients. First-line therapies for CPA (itraconazole and/or voriconazole) are often curtailed due to toxicity or the development of drug resistance. Posaconazole is a potential alternative for these patients.

METHODS:

Use of posaconazole was funded by the National Health Service Highly Specialised National Commissioners on an individual basis for patients who failed or did not tolerate first-line therapy; those who met predefined criteria for improvement at 4 and 6 months (weight gain and/or improvement in St George's Respiratory Questionnaire) continued posaconazole long-term. We recorded response, failure, discontinuation rates, and adverse events.

RESULTS:

Seventy-eight patients received posaconazole as salvage therapy. Thirty-four (44%) achieved targets for continuation of therapy. Fourteen (18%) failed therapy; five (36%) patients did not achieve clinical targets at 4 or 6 months of assessment and nine (64%) developed clinical and/or radiological failure. Twenty-eight (36%) discontinued their trial early; 8 (29%) died and 20 (71%) had significant side effects. One patient was non-compliant and another was lost to follow up.

CONCLUSIONS:

Establishing criteria for therapeutic success offered a clear, safe and sustainable method of identifying patients who benefit from additional therapy, and minimised continuation of ineffective therapy in those who did not.

• Authors: Isabel Rodriguez-Goncer, Chris Harris, Chris Kosmidis, Eavan G Muldoon, Pippa J Newton, David W Denning
• Journal: International journal of antimicrobial agents (Int J Antimicrob Agents) Vol. 52 Issue 2 Pg. 258-264 (Aug 2018) ISSN: 1872-7913 [Electronic] Netherlands
• PMID: 29906567 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Chemical References

• Antifungal Agents
• Triazoles
• posaconazole

Topics

• Adult
• Aged
• Aged, 80 and over
• Antifungal Agents (therapeutic use)
• Aspergillus fumigatus (drug effects, growth & development, pathogenicity)
• Chronic Disease
• Female
• Humans
• Male
• Middle Aged
• Pulmonary Aspergillosis (drug therapy, microbiology, mortality, pathology)
• Retrospective Studies
• Salvage Therapy (methods)
• Surveys and Questionnaires
• Survival Analysis
• Treatment Outcome
• Triazoles (therapeutic use)