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Published on: March 22, 2012
Outcome Analysis of Breakthrough Invasive Aspergillosis on Anti-Mold Azole Prophylaxis and Treatment: 30-Year
Hiba Dagher1, Anne-Marie Chaftari1, Andrea Haddad1
1Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Background:
Anti-mold azoles have improved the outcomes of invasive aspergillosis (IA) when used therapeutically, but they are extensively used as prophylaxis. There are limited data regarding the outcomes of patients with hematologic malignancy who develop breakthrough IA on anti-mold azoles. We aimed to determine whether breakthrough IA on azole prophylaxis shows worse outcomes compared to no prophylaxis.
Methods:
We compared outcomes including therapy response and mortality between antifungal regimens in hematologic malignancy patients with IA between July 1993 and July 2023.
Results:
Compared to an amphotericin B-containing regimen (AMB), an anti-mold azole as the primary therapy was independently associated with successful response at the end of therapy (OR = 4.38, p < 0.0001), protective against 42-day IA-associated mortality (OR = 0.51, p = 0.024) or all cause mortality (OR = 0.35, p < 0.0001), and protective against 84-day mortality, both IA-associated (OR = 0.50, p = 0.01) and all-cause mortality (OR = 0.27, p < 0.0001). Azole prophylaxis was independently associated with higher IA-associated mortality at 42 days (OR = 1.91, p = 0.012) and 84 days (OR = 2.03, p = 0.004), compared to fluconazole or no prophylaxis.
Conclusions:
Patients with breakthrough IA on anti-mold azole prophylaxis show a worse prognosis than those on other or no prophylaxis, possibly related to the emergence of azole resistance due to their widespread use as prophylaxis agents. On the other hand, anti-mold azole primary therapy is superior to AMB therapy in the treatment of IA.
Insights
Patients with breakthrough invasive aspergillosis (IA) on anti-mold azole prophylaxis face worse outcomes. Anti-mold azole therapy is superior to amphotericin B for treating IA.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Anti-mold azoles are widely used for invasive aspergillosis (IA) prophylaxis in patients with hematologic malignancy.
- Limited data exist on outcomes for patients developing breakthrough IA while on azole prophylaxis.
Purpose of the Study:
- To compare outcomes of breakthrough IA in hematologic malignancy patients on azole prophylaxis versus those without prophylaxis.
- To evaluate the efficacy of anti-mold azole therapy versus amphotericin B in treating IA.
Main Methods:
- Retrospective comparison of outcomes in hematologic malignancy patients with IA.
- Analysis of therapy response and mortality rates between July 1993 and July 2023.
- Comparison of antifungal regimens including azoles and amphotericin B.
Main Results:
- Anti-mold azole primary therapy showed superior response and reduced mortality compared to amphotericin B regimens.
- Azole prophylaxis was associated with increased IA-associated mortality at 42 and 84 days compared to fluconazole or no prophylaxis.
- Breakthrough IA on azole prophylaxis indicated a worse prognosis.
Conclusions:
- Patients with breakthrough IA on anti-mold azole prophylaxis have a poorer prognosis, potentially due to azole resistance.
- Anti-mold azole primary therapy is more effective than amphotericin B for treating IA.
- Widespread azole prophylaxis may contribute to resistance and worse outcomes.
