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There are limited data on the use of posaconazole oral suspension (POS) as a maintenance treatment for invasive fungal infection (IFI) following initial treatment with an intravenous (IV) antifungal agent/s.

To describe a population of patients who received POS following previous IV antifungal treatment for possible, probable, or proven IFI and describe the IV antifungal agents prescribed in those patients, prior to POS, the rationale for initiating POS maintenance therapy, and the dose and duration of POS received.

A retrospective analysis of 25 consecutive eligible adult patients who received oral POS following IV antifungal treatment was conducted in three hematology centers in the UK. Study data were obtained from hospital records, including patient case notes and hospital administrative and clinical databases. Data is presented as descriptive statistics.

Description of patient population: The patient population reported in this analysis comprises 25 adults with a median age of 54 years (interquartile range [IQR]: 43-61 years), of whom 15 were male and 22 were defined as White British. The most common primary diagnosis was acute myeloid leukaemia (n=13). 7 patients had a previous IFI prior to the case under review; 7 had documented long-term immunosuppression, and 17 patients were stem cell transplant recipients.

Antifungal treatment: 12 out of 25 patients received prophylaxis prior to this episode of IFI. All patients were given IV antifungal treatment prior to the initiation of oral POS maintenance treatment. The two most commonly prescribed IV antifungal treatments prior to POS initiation were either caspofungin or liposomal amphotericin B. The most common reasons for treatment initiation were; persistent temperature and suspicious CT result. For the majority of the patients who were subsequently prescribed POS the center attributed rationale for doing so, was to “facilitate hospital discharge” (n=16). All 25 patients received POS at the normal recommended dose; of the 19 patients with a recorded stop date, the median duration of POS therapy was 27 days (IQR: 15-87.5 days). Table 1 shows the mean number of diagnostic and monitoring tests of those patients that had the specified test.

This analysis suggests that in a UK patient population diagnosed with hematological malignancy and receiving treatment for an IFI, POS is frequently used following iv therapy, as a step-down treatment. Physicians most frequently stated that this treatment decision was to allow the early discharge of patients from hospital. The sample size although relatively small, has similar demographics to already published data. Use of POS, by allowing the discontinuation of iv therapy, may reduce the burden on hospital resources and may deliver considerable cost savings to the NHS by decreasing length of stay. Furthermore, other benefits may include allowing patients to receive treatment at home, in their preferred environment, where appropriate and also reduce the risk of nosocomial infections.