Prevention of invasive fungal infections in immunocompromised patients: the role of delayed-release posaconazole

Figures & data

Figure 1 The structural formula of posaconazole.

Table 1 Comparative studies in adult patients investigating posaconazole oral suspension prophylaxis against invasive fungal infections

Author	Study design	Study population	Study population age range (years)	Underlying immunocompromised diseases	Posaconazole	Comparator drugs	Outcome
Cornely et al^Citation34	Randomized, multicenter	602	13–82	AML, MDS	n=304; 200 mg oral susp tid	n=240, FLC 400 mg oral susp qd; n=58, ITC 200 mg oral sol bid	IFI: 7 in Pos, 25 in FLC/ITC (P<0.001); IA: 2 in Pos, 20 in FLC/ITC (P<0.001); Mort: 49 in Pos, 67 in FLC/IT (P=0.048)
Ullmann et al^Citation35	Randomized, double-blind	600	13–72	HSCT-GVHD	n=301; 200 mg oral susp tid	n=299; FLC 400 mg tb qd	IFI: 16 in Pos, 27 in FLC (P=0.07); IA: 7 in Pos, 21 in FLC (P=0.006); Mort: 76 in Pos, 84 in FLC (P=0.046)
Shen et al^Citation52	Randomized, multicenter	252	?	AML, MDS	n=129	n=123 FLC	IFI: 11 in Pos, 26 in FLC (P=0.01)
Kung et al^Citation53	Retrospective cohort, single- center	130	21–83	AML, MDS	n=65, 200 mg oral susp tid	n=65; FLC 400 mg oral qd	IFI: 6 in Pos, 17 in FLC (P=0.012); Mort: 23% in Pos, 25% in FLC (P=0.72)
Girmenia et al^Citation54	Single-center	157	20–77	AML	n=99, 200 mg oral susp tid	n=58; ampB oral susp	IFI: 23 in Pos, 30 in ampB (P=0.0002); IA: 15 in Pos, 25 in ampB (P=0.0002); Mort: 52 in Pos, 29 in ampB (P=0.08)
Peterson et al^Citation55	Retrospective cohort	200	18–77	AML, MDS, HSCT	n=100, 200 mg oral susp tid	n=100, none	IFI: 28 in Pos, 57 in none
Vehreschild et al^Citation56	Prospective cohort	159	18–76	AML	n=77; 200 mg oral susp tid	n=82; topical polyene	IFI: 3 in Pos, 16 in polyene (P=0.003); IA: 2 in Pos, 11 in polyene (P=0.018)
Sánchez-Ortega et al^Citation57	Observational, single-center	49	20–68	HSCT (AML-MDS, ALL)	n=33, 200 mg oral susp tid	n=16, ITC either oral or IV 200 mg bid	IFI: 0% in Pos, 12% in ITC (P=0.04)
Pagano et al^Citation58	Multicenter, prospective	353	44–67	AML	n=260, 200 mg oral susp tid	n=93 ITC; 2.5 mg/kg oral susp bid	IFI: 18.9% in Pos, 38.7% in ITC (P<0.01); Mort: 3.5% in Pos, 9.7% in ITC (P=0.02)
Wang et al^Citation59	Single-center, retrospective	52	23–51	HSCT	n=12, 200 mg oral susp tid	n=40, FLC 100–400 mg/day oral tb qd	IFI: 1 in Pos, 17 in FLC (P=0.039)
Devanlay et al^Citation60	Single-center, retrospective	91	23–80	AML	n=52; 200 mg oral susp tid	n=39; FLC 400 mg po qd	IFI: 8 in Pos, 9 in FLC (P=1.0)
Chaftari et al^Citation61	Randomized, prospective	46	20–69	HSCT	n=21; 200 mg oral susp tid	n=19 ABLC 7.5 mg/kg IV weekly	IFI: 0 in Pos, 1 in ABLC (P=0.48)

Abbreviations: ABLC, amphotericin B lipid complex; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; ampB, amphotericin B; FLC, fluconazole; GVHD, graft-versus-host disease; HSCT, hematopoietic stem cell transplantation; IA, invasive aspergillosis; IFI, invasive fungal infection; ITC, itraconazole; IV, intravenous; MDS, myelodysplastic syndrome; Mort, mortality; po, per oral; Pos, posaconazole; sol, ; susp, suspension; tb, tablet; tid, three times a day; bid, twice a day; qd, every day.

Table 2 Clinical trials in pediatric patients investigating posaconazole oral suspension prophylaxis against invasive fungal infections

Author	Study design	Study population n	Study population age range	Underlying immunocompromised state	Pos group	Comparator drugs	Outcome
Döring et al^Citation37	Retrospective, single-center	93	9 months to 17.7 years	AML, ALL, MDS, NHL, solid tumors	n=30; 4 mg/kg tid	n=32; FLC 5 mg/kg/day; ITC 5 mg/kg bid	IFI: 1 in Pos, 5 in FLC/ITC
Döring et al^Citation38	Retrospective, single-center	60	<12 years	HSCT	n=60; 5 mg/kg bid, 4 mg/kg tid	None	No IFI
Döring et al^Citation39	Retrospective, single-center	150	0.6–17.7 years	HSCT	n=50; 4 mg/kg tid	n=50; ITC 5 mg/kg bid, n=50; Vor 2×100 mg (BW <40 kg)	IFI: 2 in ITC, 3 in Vor
Yunus et al^Citation40	Observational, single-center	36	10 months to 17 years	AML, recurrent leukemias	200 mg tid	Vor 2×200 mg/day (BW >40 kg)	No IFI

Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; bid, twice daily; BW, body weight; FLC, fluconazole; HSCT, hematopoietic stem cell transplantation; IFI, invasive fungal infection; ITC, itraconazole; MDS, myelodysplastic syndrome; NHL, non-hodgkin lymphoma; Pos, posaconazole; tid, twice daily; Vor, voriconazole.

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