1664. Voriconazole Plus Echinocandin Versus Voriconazole Monotherapy of Invasive Aspergillosis in Solid Organ Transplant Recipients: PATH Alliance Registry Analysis
Session: Poster Abstract Session: Pre-emptive Therapy in Transplantation and Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • 1664 Husain IDWeek2013 PATH IFIs in SOTR VRC.pdf (7.3 MB)
  • Background: Invasive aspergillosis (IA) remains a major cause of morbidity and mortality in solid organ transplant recipients (SOTR). The role of voriconazole (VRC) + echinocandin (ECH) combination therapy as compared with VRC for the primary treatment of IA is not well studied.

    Methods: We utilized the Prospective Antifungal Therapy (PATH) Alliance registry network which comprises 25 centers from United States and Canada. Proven and probable IA based on Mycosis Study Group criteria were identified prospectively from July 1, 2004 through September 30, 2008, and investigator-chosen therapies were recorded. The primary outcome assessed was a composite outcome of death or no response to therapy vs complete or partial response at 12 weeks of antifungal therapy. Propensity scores were developed for the likelihood of combination therapy or monotherapy to account for selection bias. A propensity-stratified, weighted risk difference and a propensity-matched risk difference were calculated, and a logistic regression was conducted, weighted by Inverse Probability of Treated Weighted (IPTW) method. For the stratified risk difference, extreme propensities were excluded (<0.10 or >0.90); the propensity-matched method found 40 pairs; and, the IPTW model included all data.

    Results: The study population included 145 SOTR with IA and VRC usage (95 VRC monotherapy; 50 VRC+ECH combination therapy). In the overall cohort, crude 12-week positive outcome was 34% for VRC+ECH patients vs. 32% for VRC monotherapy patients (risk difference 2%; 95% CI: 19, 0.14). The propensity-stratified risk difference was 0.004 (95% CI: 0.1789, 0.1869). The propensity-matched risk difference was 0.05 (0.255, 0.155). The IPTW-weighted odds ratio for positive outcome (VRC monotherapy/VRC+ECH) was 0.92 (95% CI: 0.45, 1.88).

    Conclusion: Comparison of VRC+ECH for therapy of IA in SOTR using one of the largest cohorts of SOTR available failed to detect an advantage over VRC monotherapy.

    Shahid Husain, MD1, Fernanda Silveira, MD, MS2, Nkechi Azie, MD3, Billy Franks, PhD3 and David Horn, MD4, (1)University of Toronto, Toronto, ON, Canada, (2)University of Pittsburgh, Pittsburgh, PA, (3)Astellas Scientific and Medical Affairs, Inc., Northbrook, IL, (4)David Horn, LLC, Doylestown, PA


    S. Husain, Astellas: Consultant and Grant Investigator, Consulting fee and Research grant
    Pfizer: Consultant and Grant Investigator, Consulting fee and Research grant
    Merck: Consultant and Grant Investigator, Consulting fee and Research grant

    F. Silveira, None

    N. Azie, Astellas: Employee, Salary

    B. Franks, Astellas: Employee, Salary

    D. Horn, David Horn LLC: Consultant, Consulting fee

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