Kontoyiannis, Dimitrios P., Selleslag, Dominik, Mullane, Kathleen, Cornely, Oliver A., Hope, William ORCID: 0000-0001-6187-878X, Lortholary, Olivier, Croos-Dabrera, Rodney, Lademacher, Christopher, Engelhardt, Marc and Patterson, Thomas F.
(2018).
Impact of unresolved neutropenia in patients with neutropenia and invasive aspergillosis: a post hoc analysis of the SECURE trial.
J. Antimicrob. Chemother., 73 (3).
S. 757 - 764.
OXFORD:
OXFORD UNIV PRESS.
ISSN 1460-2091
Abstract
Historically, baseline neutropenia and lack of neutrophil recovery have been associated with poor outcomes in invasive aspergillosis (IA). It is unclear how treatment with the new Aspergillus-active triazoles isavuconazole and voriconazole affects outcomes in neutropenic patients with IA. A post hoc analysis of the Phase 3 SECURE trial assessed patients with neutropenia (neutrophil count < 0.5aYxaY10(9)/L for > 10 days at baseline) with IA (proven/probable) who had received either isavuconazole or voriconazole. The primary endpoint was all-cause mortality (ACM) through day 42. ACM in patients with resolved versus unresolved neutropenia at day 7 and overall success at end of treatment (EOT) were also assessed. One hundred and forty-two patients with neutropenia and IA were included (isavuconazole n = 78, voriconazole n = 64). ACM through day 42 (primary endpoint), day 7 and EOT were higher for patients with unresolved versus resolved neutropenia at each timepoint (day 42, unresolved: 45.0% isavuconazole, 45.2% voriconazole; resolved: 5.0% isavuconazole, 5.9% voriconazole; day 7, unresolved: 31.0% isavuconazole, 29.8% voriconazole; resolved: 5.0% isavuconazole, 5.9% voriconazole; EOT, unresolved: 48.6% isavuconazole, 36.4% voriconazole; resolved: 5.0% isavuconazole, 14.3% voriconazole). ACM was significantly higher for isavuconazole-treated patients with unresolved versus resolved neutropenia (day 7, P = 0.031; day 42, P < 0.001; EOT, P < 0.001). In voriconazole-treated patients, ACM was significantly higher among patients with unresolved versus resolved neutropenia at day 42 (P = 0.002) and numerically higher at day 7 and EOT (P > 0.05 for both). Isavuconazole had comparable efficacy and safety to voriconazole in neutropenic patients with IA. Resolution of neutropenia was associated with improved outcomes.
Item Type: | Journal Article | ||||||||||||||||||||||||||||||||||||||||||||
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URN: | urn:nbn:de:hbz:38-194560 | ||||||||||||||||||||||||||||||||||||||||||||
DOI: | 10.1093/jac/dkx423 | ||||||||||||||||||||||||||||||||||||||||||||
Journal or Publication Title: | J. Antimicrob. Chemother. | ||||||||||||||||||||||||||||||||||||||||||||
Volume: | 73 | ||||||||||||||||||||||||||||||||||||||||||||
Number: | 3 | ||||||||||||||||||||||||||||||||||||||||||||
Page Range: | S. 757 - 764 | ||||||||||||||||||||||||||||||||||||||||||||
Date: | 2018 | ||||||||||||||||||||||||||||||||||||||||||||
Publisher: | OXFORD UNIV PRESS | ||||||||||||||||||||||||||||||||||||||||||||
Place of Publication: | OXFORD | ||||||||||||||||||||||||||||||||||||||||||||
ISSN: | 1460-2091 | ||||||||||||||||||||||||||||||||||||||||||||
Language: | English | ||||||||||||||||||||||||||||||||||||||||||||
Faculty: | Unspecified | ||||||||||||||||||||||||||||||||||||||||||||
Divisions: | Unspecified | ||||||||||||||||||||||||||||||||||||||||||||
Subjects: | no entry | ||||||||||||||||||||||||||||||||||||||||||||
Uncontrolled Keywords: |
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Refereed: | Yes | ||||||||||||||||||||||||||||||||||||||||||||
URI: | http://kups.ub.uni-koeln.de/id/eprint/19456 |
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