Optimizing antifungal prophylaxis in allogeneic stem cell transplantation: A cohort study of two different approaches.

Autor: Selby PR; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.; Pharmacy Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Warner MS; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.; Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.; SA Pathology, Adelaide, South Australia, Australia., Peake SL; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.; Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia., Bardy P; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.; Haematology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Hiwase D; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.; SA Pathology, Adelaide, South Australia, Australia.; Haematology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.; Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia., Singhal D; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.; SA Pathology, Adelaide, South Australia, Australia.; Haematology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.; Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia., Beligaswatte A; Haematology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia., Hahn U; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.; SA Pathology, Adelaide, South Australia, Australia.; Haematology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Roberts JA; University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.; Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Queensland, Australia.; Department of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.; Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France., Yeung D; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.; SA Pathology, Adelaide, South Australia, Australia.; Haematology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.; Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia., Shakib S; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.; Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Jazyk: angličtina
Zdroj: Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2022 Dec; Vol. 24 (6), pp. e13988. Date of Electronic Publication: 2022 Nov 15.
DOI: 10.1111/tid.13988
Abstrakt: Background: Limited consensus exists on the optimal use of antifungal agents to prevent invasive fungal infection in the early post allogeneic hematopoietic stem cell transplant (alloHCT) period, particularly when patients cannot tolerate oral medication administration.
Methods: We undertook a retrospective observational cohort study to assess the tolerability, efficacy, and cost of a new antifungal prophylaxis pathway at a major tertiary alloHCT centre. Patients aged ≥16 years who underwent alloHCT between February 2018 and October 2019 (cohort 1) or between April 2020 and November 2021 (cohort 2) were included. In both cohorts, first line prophylactic therapy was oral posaconazole. The second line drugs where oral therapy was unable to be administered were intravenous voriconazole (cohort 1) versus intravenous posaconazole (cohort 2).
Results: There were 142 patients enrolled in the study, 71 in each cohort. The proportion of patients remaining on first-line prophylaxis or progressing to second-, third-, and fourth-line options was 22.5%, 39.4%, 29.6%, and 8.5% in cohort 1 and 39.4%, 59.2%, 1.4%, and 0% in cohort 2, respectively. The frequency of neuropsychiatric adverse events was significantly higher in cohort 1 compared to cohort 2 (49.3% vs. 19.8%, p = .0004). Occurrence of proven and probable fungal infections was not significantly different between cohorts. Antifungal drug expenditure was $359 935 (AUD) more in cohort 1 ($830 486 AUD) compared to cohort 2 ($477 149 AUD).
Conclusion: The antifungal prophylaxis pathway used in cohort 2 resulted in reduced antifungal-associated adverse effects, less patients requiring progression to 3rd and 4th line prophylaxis and reduced antifungal drug costs.
(© 2022 The Authors. Transplant Infectious Disease published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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