An open-label randomized trial comparing itraconazole oral solution with fluconazole oral solution for primary prophylaxis of fungal infections in patients with haematological malignancy and profound neutropenia
Axel Glasmacher,Oliver A. Cornely,Andrew J. Ullmann,Ulrich Wedding,Heinrich Bodenstein,Hannes Wandt,Christian Boewer,Rita Pasold,Hans-Heinrich Wolf,Mathias Hänel,Gottfried Dölken,Christian Junghanss,Reinhard Andreesen,Hartmut Bertz +13 more
TLDR
There were no differences in the efficacy and safety of itraconazole and fluconazole prophylaxis in neutropenic patients with haematological malignancies and no differences were detected between treatment groups in proven or suspected invasive fungal infections or other endpoints.Abstract:
OBJECTIVES: This trial studied the efficacy and safety of itraconazole and fluconazole in the prevention of invasive fungal infections in neutropenic patients with haematological malignancies. PATIENTS AND METHODS: An 8 week, open-label, randomized, parallel-group, multicentre trial comparing itraconazole oral solution (2.5 mg/kg twice daily; N=248) with fluconazole oral solution or capsules (400 mg daily; N=246) in 494 patients with anticipated profound neutropenia (i.e. neutrophil count expected to be <500 cells/mm3 for at least 10 days) from tertiary care centres. RESULTS: Invasive fungal infections were reported for 4 out of 248 patients (1.6%) in the itraconazole group and 5 out of 246 patients (2.0%) in the fluconazole group. Invasive Aspergillus infections were proven for 2 out of 248 patients (0.8%) in the itraconazole group and 3 out of 246 patients (1.2%) in the fluconazole group. For both the ITT and profoundly neutropenic populations, no differences were detected between treatment groups in proven or suspected invasive fungal infections or other endpoints. The mortality rates owing to proven invasive fungal infections were 2 out of 248 patients (0.8%) for the itraconazole group and 3 out of 246 patients (1.2%) for the fluconazole group. There was also no difference between treatment groups in the number of patients who recovered from neutropenia or in the duration of neutropenia. More discontinuation of drug intake owing to nausea and more hypokalaemia occurred in the itraconazole group, other adverse events and the total number of adverse events were similar in both groups. CONCLUSIONS: In this study there were no differences in the efficacy and safety of itraconazole and fluconazole prophylaxis in neutropenic patients with haematological malignancies.read more
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Posaconazole vs. Fluconazole or Itraconazole Prophylaxis in Patients with Neutropenia
Oliver A. Cornely,Johan Maertens,Drew J. Winston,John R. Perfect,Andrew J. Ullmann,Thomas J. Walsh,David Helfgott,Jerzy Holowiecki,Dick Stockelberg,Yeow Tee Goh,Mario Petrini,Cathy Hardalo,Ramachandran Suresh,David Angulo-Gonzalez +13 more
TL;DR: In patients undergoing chemotherapy for acute myelogenous leukemia or the myelodysplastic syndrome, posaconazoles prevented invasive fungal infections more effectively than did either fluconazole or itraconazole and improved overall survival.
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Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline
Andrew J. Ullmann,José María Aguado,S. Arikan-Akdagli,David W. Denning,Andreas H. Groll,Katrien Lagrou,Cornelia Lass-Flörl,Russell E. Lewis,Patricia Muñoz,Paul E. Verweij,Adilia Warris,Florence Ader,Florence Ader,Murat Akova,Maiken Cavling Arendrup,Rosemary Ann Barnes,Catherine Beigelman-Aubry,Catherine Beigelman-Aubry,Stijn Blot,Stijn Blot,Stijn Blot,Emilio Bouza,Roger J. M. Brüggemann,Dieter Buchheidt,Jacques Cadranel,Jacques Cadranel,Elio Castagnola,Arunaloke Chakrabarti,Manuel Cuenca-Estrella,George Dimopoulos,George Dimopoulos,Jesús Fortún,Jean-Pierre Gangneux,Jorge Garbino,Werner J. Heinz,Raoul Herbrecht,Claus Peter Heussel,Christopher C. Kibbler,Nikolay Klimko,Bart Jan Kullberg,Christoph Lange,Thomas Lehrnbecher,Jürgen Löffler,Olivier Lortholary,J Maertens,O. Marchetti,Jacques F. Meis,Livio Pagano,Patricia Ribaud,Malcolm Richardson,Emmanuel Roilides,Markus Ruhnke,Maurizio Sanguinetti,Donald C. Sheppard,János Sinkó,Anna Skiada,Maria J G T Vehreschild,Claudio Viscoli,Oliver A. Cornely +58 more
TL;DR: Treatment duration for aspergillosis is strongly recommended based on clinical improvement, degree of immunosuppression and response on imaging, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended.
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Interventions for treating oral mucositis for patients with cancer receiving treatment.
Helen V Worthington,Jan E Clarkson,Gemma Bryan,Susan Furness,Anne-Marie Glenny,Anne Littlewood,Martin G. McCabe,Stefan Meyer,Tasneem Khalid +8 more
TL;DR: There is weak and unreliable evidence that low level laser treatment reduces the severity of the mucositis, and new interventions for treating mucositIS are needed.
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Invasive Aspergillosis: Epidemiology, Diagnosis and Management in Immunocompromised Patients
TL;DR: Prophylactic systemic antifungal treatment with posaconazole significantly improves survival and reduces IA in acute myeloid leukaemia patients and reduces aspergillosis incidence rates in patients with intermediate-to-severe graft-versus-host reaction emerging after allogeneic haematopoietic stem cell transplantation.
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ESCMID* guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT)
Andrew J. Ullmann,Murat Akova,Raoul Herbrecht,Claudio Viscoli,Maiken Cavling Arendrup,Sevtap Arikan-Akdagli,Matteo Bassetti,Jacques Bille,Thierry Calandra,Elio Castagnola,Oliver A. Cornely,J.P. Donnelly,Jorge Garbino,Andreas H. Groll,William W. Hope,Henrik Jeldtoft Jensen,Bart Jan Kullberg,Cornelia Lass-Flörl,O. Lortholary,O. Lortholary,Wouter Meersseman,Georgios Petrikkos,Malcolm Richardson,Emmanuel Roilides,Paul E. Verweij,Manuel Cuenca-Estrella +25 more
TL;DR: This part of the ESCMID guidelines focuses on this patient population and reviews pertaining to prophylaxis, empirical/pre-emptive and targeted therapy of Candida diseases, although a warning for resistance is expressed.
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