Revista de agentes antimicrobianos

Assessment of Posaconazole Salvage Therapy in Chronic Pulmonary Aspergillosis by Using Predefined Response Criteria

Abstract

Goncer IR, Harris C, Kosmidis C, Muldoon EG, Newton PJ and Denning DW

Objective: Chronic pulmonary aspergillosis (CPA) is a progressive infection that destroys lung tissue in immune competent patients. First-line therapies for CPA (itraconazole and/or voriconazole) are often curtailed due to toxicity or the development of drug resistance. Posaconazole is a potential alternative for these patients, but it is a high-cost medication.
Methods: Use of posaconazole was funded by the NHS Highly Specialised National Commissioners on an individual basis for patients who failed or did not tolerate first line therapy; those who met predefined criteria for improvement at 4 and 6 months (weight gain and/or improvement in St George’s Respiratory Questionnaire) continued posaconazole long-term. We recorded response, failure, discontinuation rates and adverse events.
Results: Seventy-eight patients received posaconazole as salvage therapy. Thirty-four (44%) achieved targets for continuation of therapy. Fourteen (18%) failed therapy; 5 (36%) patients did not achieve clinical targets at 4 or 6 months of assessment and 9 (64%) developed clinical and/or radiological failure. Twenty-eight (36%) discontinued their trial early; 8 (29%) died and 20 (71%) had significant side effects. One patient was non-compliant and another was lost to follow-up.
Conclusions: Establishing criteria for therapeutic success offered a clear, safe and sustainable method of identifying patients who benefit from additional therapy and minimised continuation of ineffective therapy in those who did not.