Impact of unresolved neutropenia in patients with neutropenia and invasive aspergillosis: a post hoc analysis of the SECURE trial.
J Antimicrob Chemother
; 73(3): 757-763, 2018 03 01.
Article
em En
| MEDLINE
| ID: mdl-29194488
ABSTRACT
Background:
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.Methods:
A post hoc analysis of the Phase 3 SECURE trial assessed patients with neutropenia (neutrophil count <0.5â×â109/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.Results:
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).Conclusions:
Isavuconazole had comparable efficacy and safety to voriconazole in neutropenic patients with IA. Resolution of neutropenia was associated with improved outcomes.
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Aspergilose Pulmonar Invasiva
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Antifúngicos
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Neutropenia
Tipo de estudo:
Clinical_trials
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Etiology_studies
Limite:
Adult
/
Aged
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Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Antimicrob Chemother
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Estados Unidos