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

TitleAssessment of posaconazole salvage therapy in chronic pulmonary aspergillosis using predefined response criteria.
Publication TypeJournal Article
Year of Publication2018
AuthorsRodriguez-Goncer, I, Harris, C, Kosmidis, C, Muldoon, EG, Newton, PJ, Denning, DW
JournalInt J Antimicrob Agents
Volume52
Issue2
Pagination258-264
Date Published2018 Aug
ISSN1872-7913
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.

DOI10.1016/j.ijantimicag.2018.06.001
Alternate JournalInt. J. Antimicrob. Agents
PubMed ID29906567