Related Experiment Video
Updated: Jul 16, 2025
A Contemporary Warming/Restraining Device for Efficient Tail Vein Injections in a Murine Fungal Sepsis Model
Published on: November 6, 2020
Invasive fungal infection following venetoclax and posaconazole co-administration
Gemma Reynolds1,2, Karen F Urbancic1,3,4, Chun Y Fong5
1Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia.
Abstract:
The co-administration of venetoclax, a BCL-2 inhibitor, with a mould-active azole, such a posaconazole, has potential to both prevent invasive fungal infection (IFI) and reduce the required treatment dose, and cost, of venetoclax. Posaconazole drug-level monitoring is critical to ensuring adequate mould prophylaxis. A retrospective audit of 99 patients at a tertiary cancer centre, with myeloid malignancies co-prescribed venetoclax and posaconazole between January 2018 and April 2022, was undertaken to evaluate the adequacy of posaconazole prescribing and the rate of breakthrough IFI. Seventy-six patients (77%) had at least one posaconazole level measured in the study period, with 37% requiring a dose adjustment based on steady-state trough levels. Breakthrough IFI occurred in 4% of patients, typically within 1 month of commencing anti-mould prophylaxis. Close monitoring of posaconazole levels in venetoclax-treated patients, particularly in the early, outpatient setting, is critical.
Insights
Monitoring posaconazole levels is crucial for patients with myeloid malignancies receiving venetoclax. This ensures adequate antifungal prophylaxis and guides necessary dose adjustments, minimizing breakthrough invasive fungal infections (IFI).
Area of Science:
- Oncology
- Infectious Diseases
- Pharmacology
Background:
- Venetoclax, a BCL-2 inhibitor, is used in myeloid malignancies.
- Co-administration with posaconazole may prevent invasive fungal infections (IFI) and reduce venetoclax costs.
- Adequate posaconazole drug levels are essential for effective prophylaxis.
Purpose of the Study:
- To evaluate the adequacy of posaconazole prescribing in patients co-prescribed venetoclax.
- To determine the rate of breakthrough IFI in this patient cohort.
- To assess the impact of posaconazole drug-level monitoring on dose adjustments.
Main Methods:
- Retrospective audit of 99 patients with myeloid malignancies.
- Patients received concurrent venetoclax and posaconazole (January 2018 - April 2022).
- Analysis of posaconazole levels and breakthrough IFI events.
Main Results:
- 77% of patients had at least one posaconazole level measured.
- 37% required posaconazole dose adjustment based on trough levels.
- Breakthrough IFI occurred in 4% of patients, mostly within the first month.
Conclusions:
- Close posaconazole drug-level monitoring is critical for venetoclax-treated patients.
- Monitoring is particularly important in the early outpatient setting.
- Ensuring therapeutic posaconazole levels aids in preventing IFI and optimizing treatment.
Related Concept Videos
01:30Venous Thrombosis IV: Nursing Management
01:29Fungal Group Zygomycota
01:29Endocarditis IV: Nursing Management
01:29Venous Thrombosis III: Interprofessional Care
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids