Universität zu Köln

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

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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
Creators:	Creators Email ORCID ORCID Put Code Kontoyiannis, Dimitrios P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Selleslag, Dominik UNSPECIFIED UNSPECIFIED UNSPECIFIED Mullane, Kathleen UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, Oliver A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hope, William UNSPECIFIED orcid.org/0000-0001-6187-878X UNSPECIFIED Lortholary, Olivier UNSPECIFIED UNSPECIFIED UNSPECIFIED Croos-Dabrera, Rodney UNSPECIFIED UNSPECIFIED UNSPECIFIED Lademacher, Christopher UNSPECIFIED UNSPECIFIED UNSPECIFIED Engelhardt, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Patterson, Thomas F. UNSPECIFIED UNSPECIFIED UNSPECIFIED
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:	Keywords Language MYCOSES STUDY-GROUP; CARE CANCER CENTER; HEMATOLOGICAL MALIGNANCIES; EUROPEAN-ORGANIZATION; CELL TRANSPLANTATION; PROGNOSTIC-FACTORS; FUNGAL DISEASES; GALACTOMANNAN; MORTALITY; THERAPY Multiple languages Infectious Diseases; Microbiology; Pharmacology & Pharmacy Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19456