Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Lenczuk, D.
Retrospective analysis of plasma levels and efficacy of antifungal prophylaxis with different posaconazole formulations
Humanmedizin; [ Diplomarbeit/Master Thesis (UNI) ] Graz Medical University; 2018. pp.60.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Krause Robert
- Zinke-Cerwenka Wilma
- Altmetrics:
- Abstract:
- Background Posaconazole is a broad spectrum antifungal drug used as a prophylactic agent in patients receiving induction chemotherapy for hematological malignancies and in those for whom immunosuppressive drugs are needed to prevent GvHD after HSCT. These patients have a high risk of invasive fungal disease. Methods This retrospective study conducted from June 2015 until December 2016 in Graz, analyzed 97 patients of which 61 were enrolled, 48 were on delayed-release tablet and 13 on oral suspension formulation. Their medical data, microbiological data, laboratory data, and medications were extracted from patient’s charts via Medocs. Posaconazole plasma concentrations were obtained during outpatient treatment or hospitalization. This thesis assesses the superiority of DRT during the whole period of intake compared to OS, cutoff 0.7 µg/ml. Breakthrough infections were defined as “proven”, “probable” and “possible” according to the EORTC/MSG. Results The 446 measurements of 61 patients (1 to 30 PPCs per patient) were analyzed and divided in min. one PPC (DRT 91.1% vs OS 51.6%, p-value 0.001), min. two PPCs (DRT 91.6% vs OS 56.0%, p-value 0.004) and min. three PPCs (DRT 90.7% vs OS 62.1%, p-value 0.073). Comparison of the periods day 1-6 and day 7-14 showed significant higher PPCs in the DRT group (mean 1.53 µg/ml) than in OS group (mean 0.67 µg/ml) – p-value 0.009. Only one breakthrough infection was diagnosed as Candida glabrata orbital abscess, 1.6%. No decrease in PPC was seen in patients suffering from diarrhea or taking concomitant PPI, only patients diagnosed with GvHD had lower plasma levels DRT 22/86.7% vs. OS 13/97.4%, p-value 0.026. Conclusion The posaconazole delayed-release tablet is superior compared to the oral suspension in reaching sufficient plasma concentrations during the period of intake. Therapeutic drug monitoring may be needed for selected patients only.