1. Matched-paired analysis of patients treated for invasive mucormycosis: standard treatment versus posaconazole new formulations (MoveOn)
- Author
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Salmanton-García, Jon, Seidel, Danila, Koehler, Philipp, Mellinghoff, Sibylle, Herbrecht, Raoul, Klimko, Nikolai, Ráčil, Zdeněk, Falces-Romero, Iker, Ingram, Paul, Benítez-Peñuela, Miguel-Ángel, Rodríguez, José Yesid, Desoubeaux, Guillaume, Barać, Aleksandra, García-Vidal, Carolina, Hoenigl, Martin, Mehta, Sanjay, Cheng, Matthew, Klyasova, Galina, Heinz, Werner, Iqbal, Nousheen, Krause, Robert, Ostermann, Helmut, Penack, Olaf, Schalk, Enrico, Sheppard, Donald, Willinger, Birgit, Wisplinghoff, Hilmar, Vehreschild, J Janne, Cornely, Oliver, Vehreschild, Maria, Khedr, Reham Abdelaziz, Arencibia-Núñez, Alberto, Avilés-Robles, Martha, Banke, Ingo, Basher, Ariful, Benachinamardi, Keertilaxmi, Bertz, Harmut, Chakrabarti, Arunaloke, Drgona, Lubos, García-Martínez, Jesús, García-Rodríguez, Julio, Gräber, Sandra, Härter, Georg, Klein, Michael, Kouba, Michal, Lee, Dong-Gun, Le Govic, Yohann, Leo, Fabian, Maertens, Johan, Maschmeyer, Georg, Meintker, Lisa, Mo, Xiao-Dong, Müller, Lena-Katharina, Müller, Nicolas, Nel, Jeremy Stephen, Novák, Jan, Patel, Atul, Pfäfflin, Frieder, Pozo-Laderas, Juan-Carlos, Puerta-Alcalde, Pedro, Rodríguez-Guardado, Azucena, Schroers, Roland, Shekar, Vandana, Shenoi, Susan, Silling, Gerda, Vinh, Donald, Waizel-Haiat, Salomón, Yee Yee, Mandy Yap, Prakash, Peralam Yegneswaran, Žák, Pavel, Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Université d'Angers (UA), Service d'Hématologie, CHU Strasbourg, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100 (CEPR), Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Medicine, Medical University Graz, Schwerpunkt Infektiologie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Department of Haematology and Oncology, Medical Clinic III, University Hospital Munich—Großhadern, Ludwig Maximilian University, Klinik für Hämatologie und Onkologie, Charité, Campus Benjamin Franklin, Department of Haematology/Oncology, Magdeburg University Hospital, McGill University = Université McGill [Montréal, Canada], Medizinische Universität Wien = Medical University of Vienna, University Hospital of Cologne [Cologne], Postgraduate Institute of Medical Education and Research, Laboratoire de psychologie cognitive (LPC), Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), Anofel Cryptosporidium National Network, Department of Hematology, University Hospital Gasthuisberg, Medizinische Klinik, Hämatologie und Onkologie, Klinikum Ernst von Bergmann, Real Expression Artificial Life (IRIT-REVA), Institut de recherche en informatique de Toulouse (IRIT), Université Toulouse 1 Capitole (UT1), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse 1 Capitole (UT1), Université Fédérale Toulouse Midi-Pyrénées, Medizinische Klinik A des Universitätsklinikums Münster, Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), University Hospital Gasthuisberg [Leuven], Université Toulouse Capitole (UT Capitole), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université Toulouse Capitole (UT Capitole), Université de Toulouse (UT), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), and Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
Male ,0301 basic medicine ,Posaconazole ,Antifungal Agents ,[SDV]Life Sciences [q-bio] ,Gastroenterology ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Amphotericin B ,Pharmacology (medical) ,Prospective Studies ,Registries ,030212 general & internal medicine ,Child ,Prospective cohort study ,[SDV.MP.MYC]Life Sciences [q-bio]/Microbiology and Parasitology/Mycology ,ComputingMilieux_MISCELLANEOUS ,Antiinfective agent ,Standard treatment ,Middle Aged ,3. Good health ,Infectious Diseases ,Tolerability ,Child, Preschool ,Mucorales ,Female ,medicine.drug ,Adult ,Microbiology (medical) ,medicine.medical_specialty ,Adolescent ,Drug Compounding ,Matched-Pair Analysis ,030106 microbiology ,Young Adult ,03 medical and health sciences ,Pharmacokinetics ,Internal medicine ,parasitic diseases ,medicine ,Humans ,Mucormycosis ,[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,[INFO]Computer Science [cs] ,Aged ,Pharmacology ,business.industry ,Infant, Newborn ,Infant ,Triazoles ,medicine.disease ,business ,MESH: amphotericin b, antifungal agents, cancer, kidney failure, mucormycosis, surgical procedures, operative, suspensions, mortality, posaconazole ,Invasive Fungal Infections - Abstract
Background First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability. Objectives Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment. Methods We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction). Results Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp]. Conclusions Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.
- Published
- 2019