Clinical effectiveness of early posaconazole suspension pre-emptive therapy in lung transplant recipients: The Alfred's experience

Wirawan Jeong, Greg I. Snell, Bronwyn J. Levvey, Glen P Westall, C Orla Morrissey, Steven Ivulich, Chin Fen Neoh, Monica A Slavin, David C M Kong

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: This study describes the clinical outcomes and therapeutic drug monitoring (TDM) following posaconazole suspension pre-emptive therapy in lung transplant (LTx) recipients. Methods: This was a single-centre, retrospective cohort study evaluating posaconazole suspension pre-emptive therapy in LTx recipients between January 2009 and December 2015. Results: Forty-two LTx recipients were prescribed posaconazole suspension pre-emptively. Aspergillus fumigatus was the most commonly isolated fungal organism. Of the patients receiving posaconazole suspension as the initial antifungal post-LTx, 93% had eradication of colonization at 6months after commencing therapy. In contrast, only 61% had eradication of fungal colonization when posaconazole suspension was administered following initial therapy with voriconazole. Posaconazole suspension appeared to be well tolerated, although one case was curtailed following concern about abnormal liver function and another due to nausea/vomiting. TDM was performed in 37 patients. The initial median (IQR) trough plasma concentration (Cmin) following 400mg twice-daily posaconazole suspension was 0.78 (0.46-1.19) mg/L. Doses beyond 800mg daily did not appear to result in a higher median Cmin Conclusions: Early initiation of posaconazole suspension pre-emptive therapy in LTx recipients appears to be well tolerated and may potentially afford favourable clinical outcomes.

Original languageEnglish
Article numberdkx085
Pages (from-to)2089-2092
Number of pages4
JournalJournal of Antimicrobial Chemotherapy
Volume72
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017

Cite this

@article{9a0b461a207846ecaef73b34f23ba30d,
title = "Clinical effectiveness of early posaconazole suspension pre-emptive therapy in lung transplant recipients: The Alfred's experience",
abstract = "Objectives: This study describes the clinical outcomes and therapeutic drug monitoring (TDM) following posaconazole suspension pre-emptive therapy in lung transplant (LTx) recipients. Methods: This was a single-centre, retrospective cohort study evaluating posaconazole suspension pre-emptive therapy in LTx recipients between January 2009 and December 2015. Results: Forty-two LTx recipients were prescribed posaconazole suspension pre-emptively. Aspergillus fumigatus was the most commonly isolated fungal organism. Of the patients receiving posaconazole suspension as the initial antifungal post-LTx, 93{\%} had eradication of colonization at 6months after commencing therapy. In contrast, only 61{\%} had eradication of fungal colonization when posaconazole suspension was administered following initial therapy with voriconazole. Posaconazole suspension appeared to be well tolerated, although one case was curtailed following concern about abnormal liver function and another due to nausea/vomiting. TDM was performed in 37 patients. The initial median (IQR) trough plasma concentration (Cmin) following 400mg twice-daily posaconazole suspension was 0.78 (0.46-1.19) mg/L. Doses beyond 800mg daily did not appear to result in a higher median Cmin Conclusions: Early initiation of posaconazole suspension pre-emptive therapy in LTx recipients appears to be well tolerated and may potentially afford favourable clinical outcomes.",
author = "Wirawan Jeong and Snell, {Greg I.} and Levvey, {Bronwyn J.} and Westall, {Glen P} and Morrissey, {C Orla} and Steven Ivulich and Neoh, {Chin Fen} and Slavin, {Monica A} and Kong, {David C M}",
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Clinical effectiveness of early posaconazole suspension pre-emptive therapy in lung transplant recipients : The Alfred's experience. / Jeong, Wirawan; Snell, Greg I.; Levvey, Bronwyn J.; Westall, Glen P; Morrissey, C Orla; Ivulich, Steven; Neoh, Chin Fen; Slavin, Monica A; Kong, David C M.

In: Journal of Antimicrobial Chemotherapy, Vol. 72, No. 7, dkx085, 01.07.2017, p. 2089-2092.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Clinical effectiveness of early posaconazole suspension pre-emptive therapy in lung transplant recipients

T2 - The Alfred's experience

AU - Jeong, Wirawan

AU - Snell, Greg I.

AU - Levvey, Bronwyn J.

AU - Westall, Glen P

AU - Morrissey, C Orla

AU - Ivulich, Steven

AU - Neoh, Chin Fen

AU - Slavin, Monica A

AU - Kong, David C M

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objectives: This study describes the clinical outcomes and therapeutic drug monitoring (TDM) following posaconazole suspension pre-emptive therapy in lung transplant (LTx) recipients. Methods: This was a single-centre, retrospective cohort study evaluating posaconazole suspension pre-emptive therapy in LTx recipients between January 2009 and December 2015. Results: Forty-two LTx recipients were prescribed posaconazole suspension pre-emptively. Aspergillus fumigatus was the most commonly isolated fungal organism. Of the patients receiving posaconazole suspension as the initial antifungal post-LTx, 93% had eradication of colonization at 6months after commencing therapy. In contrast, only 61% had eradication of fungal colonization when posaconazole suspension was administered following initial therapy with voriconazole. Posaconazole suspension appeared to be well tolerated, although one case was curtailed following concern about abnormal liver function and another due to nausea/vomiting. TDM was performed in 37 patients. The initial median (IQR) trough plasma concentration (Cmin) following 400mg twice-daily posaconazole suspension was 0.78 (0.46-1.19) mg/L. Doses beyond 800mg daily did not appear to result in a higher median Cmin Conclusions: Early initiation of posaconazole suspension pre-emptive therapy in LTx recipients appears to be well tolerated and may potentially afford favourable clinical outcomes.

AB - Objectives: This study describes the clinical outcomes and therapeutic drug monitoring (TDM) following posaconazole suspension pre-emptive therapy in lung transplant (LTx) recipients. Methods: This was a single-centre, retrospective cohort study evaluating posaconazole suspension pre-emptive therapy in LTx recipients between January 2009 and December 2015. Results: Forty-two LTx recipients were prescribed posaconazole suspension pre-emptively. Aspergillus fumigatus was the most commonly isolated fungal organism. Of the patients receiving posaconazole suspension as the initial antifungal post-LTx, 93% had eradication of colonization at 6months after commencing therapy. In contrast, only 61% had eradication of fungal colonization when posaconazole suspension was administered following initial therapy with voriconazole. Posaconazole suspension appeared to be well tolerated, although one case was curtailed following concern about abnormal liver function and another due to nausea/vomiting. TDM was performed in 37 patients. The initial median (IQR) trough plasma concentration (Cmin) following 400mg twice-daily posaconazole suspension was 0.78 (0.46-1.19) mg/L. Doses beyond 800mg daily did not appear to result in a higher median Cmin Conclusions: Early initiation of posaconazole suspension pre-emptive therapy in LTx recipients appears to be well tolerated and may potentially afford favourable clinical outcomes.

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JF - Journal of Antimicrobial Chemotherapy

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