Assessment of posaconazole salvage therapy in chronic pulmonary aspergillosis using predefined response criteria.
Τίτλος | Assessment of posaconazole salvage therapy in chronic pulmonary aspergillosis using predefined response criteria. |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | Rodriguez-Goncer, I., Harris C., Kosmidis C., Muldoon E. G., Newton P. J., & Denning D. W. |
Journal | Int J Antimicrob Agents |
Volume | 52 |
Issue | 2 |
Pagination | 258-264 |
Date Published | 2018 Aug |
ISSN | 1872-7913 |
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. |
DOI | 10.1016/j.ijantimicag.2018.06.001 |
Alternate Journal | Int. J. Antimicrob. Agents |
PubMed ID | 29906567 |