Masato Tashiro1,2, Takahiro Takazono1,3, Tomomi Saijo2,3, Kazuko Yamamoto2,3,4, Yoshifumi Imamura3,5, Taiga Miyazaki1,3, Hiroshi Kakeya6, Tsunehiro Ando7, Kenji Ogawa8, Kazuma Kishi9, Issei Tokimatsu10, Yuta Hayashi8, Satoru Fujiuchi11, Katsunori Yanagihara12, Yoshitsugu Miyazaki13, Kiyoshi Ichihara14, Hiroshi Mukae3,5, Shigeru Kohno3,5, Koichi Izumikawa1,2. 1. Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences. 2. Infection Control and Education Center, Nagasaki University Hospital. 3. Department of Respiratory Medicine, Nagasaki University Hospital. 4. Clinical Research Center, National Hospital Organization Nagasaki Medical Center. 5. Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences. 6. Department of Infection Control Science, Graduate School of Medicine, Osaka City University. 7. Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo. 8. Department of Respiratory Medicine, National Hospital Organization Higashinagoya National Hospital, Nagoya. 9. Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital. 10. Department of Medicine, Division of Clinical Infectious Diseases, School of Medicine, Showa University, Tokyo. 11. Respiratory Medicine, Asahikawa Medical Center, Hokkaido. 12. Department of Laboratory Medicine, Nagasaki University Hospital. 13. Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo. 14. Department of Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Abstract
BACKGROUND: There are limited data for direct comparisons of the efficacy of oral itraconazole (ITCZ) and oral voriconazole (VRCZ) therapy in the treatment of chronic pulmonary aspergillosis (CPA). METHODS: We conducted a retrospective, follow-up, observational study of CPA patients enrolled in 2 previous multicenter trials. RESULTS: Of the 273 CPA patients, 59 and 101 patients started maintenance therapy with oral ITCZ and oral VRCZ, respectively, just after the end of acute intravenous therapy in each trial. At the end of the observation period in this follow-up study (median observation period, 731 days), the percentage of patients who showed improvement was lower in the ITCZ group than in the VRCZ group (18.2% vs 40.0%). However, after including stable patients, the percentages were 50.9% and 52.6%, respectively, in the ITCZ and VRCZ groups, which were not significantly different (P = .652). Multivariable Cox regression analysis showed no significant influence of the choice of initial maintenance treatment (ITCZ or VRCZ) on overall mortality as well as CPA-associated mortality. Multivariable logistic regression showed that oral ITCZ selection for initial maintenance therapy was an independent risk factor for hospital readmission and switching to other antifungal agents (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.3-7.5 and OR, 5.7; 95% CI, 2.0-15.7, respectively). CONCLUSIONS: Oral VRCZ for initial maintenance therapy showed better effectiveness than oral ITCZ for clinical improvement in CPA patients. There was no difference in crude mortality between initial maintenance therapy with VRCZ and ITCZ, especially in elderly CPA patients. CLINICAL TRIALS REGISTRATION: UMIN000007055.
BACKGROUND: There are limited data for direct comparisons of the efficacy of oral itraconazole (ITCZ) and oral voriconazole (VRCZ) therapy in the treatment of chronic pulmonary aspergillosis (CPA). METHODS: We conducted a retrospective, follow-up, observational study of CPA patients enrolled in 2 previous multicenter trials. RESULTS: Of the 273 CPA patients, 59 and 101 patients started maintenance therapy with oral ITCZ and oral VRCZ, respectively, just after the end of acute intravenous therapy in each trial. At the end of the observation period in this follow-up study (median observation period, 731 days), the percentage of patients who showed improvement was lower in the ITCZ group than in the VRCZ group (18.2% vs 40.0%). However, after including stable patients, the percentages were 50.9% and 52.6%, respectively, in the ITCZ and VRCZ groups, which were not significantly different (P = .652). Multivariable Cox regression analysis showed no significant influence of the choice of initial maintenance treatment (ITCZ or VRCZ) on overall mortality as well as CPA-associated mortality. Multivariable logistic regression showed that oral ITCZ selection for initial maintenance therapy was an independent risk factor for hospital readmission and switching to other antifungal agents (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.3-7.5 and OR, 5.7; 95% CI, 2.0-15.7, respectively). CONCLUSIONS: Oral VRCZ for initial maintenance therapy showed better effectiveness than oral ITCZ for clinical improvement in CPA patients. There was no difference in crude mortality between initial maintenance therapy with VRCZ and ITCZ, especially in elderly CPA patients. CLINICAL TRIALS REGISTRATION: UMIN000007055.
Authors: Christian B Laursen; Jesper Rømhild Davidsen; Lander Van Acker; Helmut J F Salzer; Danila Seidel; Oliver A Cornely; Martin Hoenigl; Ana Alastruey-Izquierdo; Christophe Hennequin; Cendrine Godet; Aleksandra Barac; Holger Flick; Oxana Munteanu; Eva Van Braeckel Journal: J Fungi (Basel) Date: 2020-06-29
Authors: Deven C Patel; Prasha Bhandari; David J Epstein; Douglas Z Liou; Leah M Backhus; Mark F Berry; Joseph B Shrager; Natalie S Lui Journal: J Thorac Dis Date: 2021-08 Impact factor: 2.895