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Antifungal prophylactic effectiveness and intrapulmonary concentrations of voriconazole versus posaconazole in lung

Chunrong Ju1, Qiaoyan Lian2, Ao Chen2

  • 1Department of Respiratory and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.

Medical Mycology
|August 29, 2022
PubMed

Insights

This study found that while posaconazole achieved higher intrapulmonary levels than voriconazole in lung transplant recipients, both antifungals demonstrated comparable effectiveness in preventing invasive fungal diseases (IFDs).

Area of Science:

  • Medicine
  • Pharmacology
  • Transplantation

Background:

  • Invasive fungal diseases (IFDs) pose a significant mortality risk for lung transplant recipients.
  • Antifungal prophylaxis is crucial in managing post-transplant IFDs.

Purpose of the Study:

  • To compare the efficacy of voriconazole and posaconazole as antifungal prophylaxis in lung transplant recipients.
  • To evaluate and compare intrapulmonary and plasma drug levels of voriconazole versus posaconazole.

Main Methods:

  • Retrospective cohort study of adult lung transplant recipients (June 2017-December 2020).
  • Analysis of voriconazole (oral tablets) versus posaconazole (oral suspension) for IFD prophylaxis.
  • Measurement of drug concentrations in bronchoalveolar lavage fluid (BALF) and plasma using liquid chromatography-mass spectrometry.

Main Results:

  • Comparable trough plasma levels were observed for voriconazole and posaconazole (1.65 ± 0.09 vs. 1.69 ± 0.03 μg/ml).
  • Significantly higher BALF levels were found for posaconazole compared to voriconazole (17.47 ± 11.51 vs. 0.56 ± 0.49 μg/ml).
  • No significant difference in the incidence of breakthrough IFDs between the two groups (10.6% vs. 7.5%).

Conclusions:

  • Posaconazole achieves higher intrapulmonary concentrations than voriconazole in lung transplant recipients.
  • Both voriconazole and posaconazole exhibit comparable prophylactic effectiveness against invasive fungal diseases in this patient population.
Keywords:
invasive fungal diseaselung transplantationposaconazoleprophylaxisvoriconazole

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