Document Detail


Efficacy and safety of posaconazole for chronic pulmonary aspergillosis.
MedLine Citation:
PMID:  21054179     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Chronic pulmonary aspergillosis (CPA) is a severe, progressive respiratory infection characterized by multiple pulmonary cavities and increased levels of antibodies to Aspergillus species. We report the first use of posaconazole in patients with CPA.
METHODS: A retrospective study was performed. A composite clinical and radiological evaluation was used to assess response to posaconazole therapy. The rates of clinical response and failure after 6 and 12 months of therapy were determined. Kaplan-Meier survival models were developed to describe the time to clinical response and failure. The underlying diagnosis, the type of therapy (primary or salvage), Aspergillus antibody titer, and posaconazole serum concentrations were assessed as covariates. Aspergillus species were identified and minimum inhibitory concentrations (MICs) of triazoles were determined using standard techniques.
RESULTS: There were 79 patients that initially received posaconazole 400 mg twice per day. The median age of patients was 61 years, and 57% were male. Response to posaconazole was observed in 61% of patients at 6 months and in 46% at 12 months. Kaplan-Meier plots showed that the first response to posaconazole was observed in some patients only after approximately 1 year of therapy. Covariates were not significant. Adverse reactions were observed in 12 patients (15%) (nausea in 5, rash in 5, headache in 1, and lethargy in 1), leading to withdrawal of treatment for 9 patients. Aspergillus species were recovered from 22 patients. A posaconazole MIC of >8 mg/L was found in 4 isolates; in 1 of these isolates, this emerged during therapy. Treatment failed in all 4 patients from whom these 4 isolates had been recovered.
CONCLUSION: Posaconazole is a safe and partially effective treatment for CPA. Prospective comparative studies are now required.
Authors:
Timothy W Felton; Caroline Baxter; Caroline B Moore; Stephen A Roberts; William W Hope; David W Denning
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-11-05
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  51     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-18     Completed Date:  2011-02-25     Revised Date:  2013-11-25    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1383-91     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Antibodies, Fungal / blood
Antifungal Agents / administration & dosage*,  adverse effects*,  pharmacokinetics,  pharmacology
Aspergillus / drug effects,  isolation & purification
Chronic Disease
Female
Humans
Lung / pathology
Male
Microbial Sensitivity Tests
Middle Aged
Pulmonary Aspergillosis / drug therapy*,  pathology
Radiography, Thoracic
Retrospective Studies
Serum / chemistry,  immunology
Treatment Failure
Treatment Outcome
Triazoles / administration & dosage*,  adverse effects*,  pharmacokinetics,  pharmacology
Chemical
Reg. No./Substance:
0/Antibodies, Fungal; 0/Antifungal Agents; 0/Triazoles; 6TK1G07BHZ/posaconazole
Comments/Corrections
Comment In:
Clin Infect Dis. 2010 Dec 15;51(12):1392-4   [PMID:  21054178 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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