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:
CreatorsEmailORCIDORCID Put Code
Kontoyiannis, Dimitrios P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Selleslag, DominikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mullane, KathleenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cornely, Oliver A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hope, WilliamUNSPECIFIEDorcid.org/0000-0001-6187-878XUNSPECIFIED
Lortholary, OlivierUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Croos-Dabrera, RodneyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lademacher, ChristopherUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Engelhardt, MarcUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Patterson, Thomas F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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:
KeywordsLanguage
MYCOSES STUDY-GROUP; CARE CANCER CENTER; HEMATOLOGICAL MALIGNANCIES; EUROPEAN-ORGANIZATION; CELL TRANSPLANTATION; PROGNOSTIC-FACTORS; FUNGAL DISEASES; GALACTOMANNAN; MORTALITY; THERAPYMultiple languages
Infectious Diseases; Microbiology; Pharmacology & PharmacyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/19456

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