Comparative evaluation of isavuconazonium sulfate, voriconazole, and posaconazole for the management of invasive fungal infections in an academic medical center

被引：24

作者：

Van Matre, Edward T. ^{[1
]}

Evans, Shelby L. ^{[2
]}

Mueller, Scott W. ^{[3
]}

MacLaren, Robert ^{[3
]}

Fish, Douglas N. ^{[3
]}

Kiser, Tyree H. ^{[3
,4
]}

机构：

[1] Univ Tennessee, Hlth Sci Ctr, Coll Pharm, Dept Clin Pharm & Translat Sci, Memphis, TN 38163 USA

[2] Univ Colorado, Dept Pharm, Hlth Mem Hosp, Colorado Springs, CO USA

[3] Univ Colorado, Dept Clin Pharm, Skaggs Sch Pharm & Pharmaceut Sci, Aurora, CO USA

[4] Univ Colorado, Dept Clin Pharm, Anschutz Med Campus,12850 East Montview Blvd, Aurora, CO 80045 USA

来源：

ANNALS OF CLINICAL MICROBIOLOGY AND ANTIMICROBIALS | 2019年 / 18卷 / 1期

关键词：

Isavuconazole; Voriconazole; Posaconazole; Mycoses; Aspergillus; TRANSPLANT RECIPIENTS; PHARMACOKINETICS; SURVEILLANCE; MUCORMYCOSIS; GUIDELINES; DIAGNOSIS;

D O I：

10.1186/s12941-019-0311-3

中图分类号：

Q93 [微生物学];

学科分类号：

071005 ; 100705 ;

摘要：

BackgroundInvasive fungal infections are a major cause of morbidity and mortality. Newer antifungals may provide similar efficacy with improved safety compared to older more established treatments. This study aimed to compare clinically relevant safety and efficacy outcomes in real world patients treated with isavuconazole, voriconazole, or posaconazole.MethodsThis single center retrospective matched cohort study evaluated adults between January 2015 and December 2017. The primary outcome was a composite safety analysis of antifungal related QTc prolongation, elevated liver function tests (>5 times ULN), or any documented adverse drug event. Key secondary outcomes included: individual safety events, 30-day readmissions, magnitude of drug interactions with immunosuppressive therapy, and overall cost.ResultsA total of 100 patients were included: 34 patients in the voriconazole group and 33 patients within each of the isavuconazole and posaconazole groups. The composite safety outcome occurred in 40% of the total cohort and was different between isavuconazole (24.2%), voriconazole (55.9%), and posaconazole (39.4%; p=0.028). Change in QTc (p<0.01) and magnitude of immunosuppression dose reduction (p=0.029) were different between the three groups. No differences in mortality, length of stay, readmission, or infection recurrence were observed between groups (p>0.05 for all). The overall medication cost, when including therapeutic drug monitoring, was not different between treatments (p=0.36).ConclusionsPatients treated with isavuconazole resulted in fewer composite safety outcomes, driven by decreased incidence of QTc prolongation, compared to patients treated with voriconazole or posaconazole. Overall drug cost was not significantly different between the treatment therapy options.

引用

页数：7

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