Tolerability of isavuconazole after posaconazole toxicity in leukaemia patients

Adam J. DiPippo, Caitlin R. Rausch, Dimitrios P. Kontoyiannis

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Background: Posaconazole (PCZ) is widely used for prophylaxis or treatment of invasive fungal infections (IFIs) in leukaemia patients. However, issues with PCZ tolerability can result in treatment interruption. Isavuconazole (ISA) has a similar broad spectrum of activity to PCZ; however, real-world data regarding the tolerability of ISA after PCZ toxicity are lacking. Objectives: To describe the tolerability of ISA after PCZ toxicity in leukaemia patients. Patients/Methods: We retrospectively assessed tolerability of ISA after PCZ toxicity in adult leukaemia patients (March 2015 to November 2017). We included all patients who received ≥7 days of ISA within 48 hours of PCZ discontinuation. Laboratory markers for liver toxicity were collected at three time points: prior to PCZ, at switch to ISA and after ISA therapy. Results: We identified 23 such patients. Increased liver function tests (LFTs) were noted in 20 patients on PCZ, while three patients had Grade 3/4 QTc prolongation. No patient discontinued subsequent ISA due to toxicity. Grade 3/4 elevations in LFTs were decreased after changing to ISA (30% after PCZ vs 5% after ISA). No patient had significant QTc prolongation after switching to ISA. Conclusions: Isavuconazole was well-tolerated in patients discontinuing PCZ due to toxicity, with no patient discontinuing ISA due to toxicity.

Original languageEnglish (US)
Pages (from-to)81-86
Number of pages6
JournalMycoses
Volume62
Issue number1
DOIs
StatePublished - Jan 2019

Keywords

  • invasive fungal infections
  • isavuconazole
  • leukaemia
  • neutropenia
  • posaconazole
  • toxicity

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

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