1579. To Compare the Safety and Efficacy of Voriconazole versus Posaconazole in the Prevention of Invasive Fungal Infections in High Risk Patients with Hematologic Malignancies or Hematopoietic Stem Cell Transplant
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Background: Invasive fungal infection (IFIs) is a leading cause of morbidity and mortality in immunocompromised hematological malignancies (HM) patients. New triazole-based antifungals agents have been recommended for prophylaxis to reduce the incidence of IFIs. We therefore conducted this study to compared the safety and efficacy of Voriconazole and Posaconazole as prophylaxis in HM patients.

Methods: This retrospective study was conducted from January 2014 to August 2015. We identified all HM patients with severe neutropenia (ANC < 500), those receiving intensive induction chemotherapy for a diagnosis of AML or MDS, as well as patients undergoing allogeneic HSCT. Patients received prophylaxis with either Voriconazole 200 mg oral tablet given twice daily or Posaconazole 300 mg oral tablets given once daily.

Results: A total of 200 patients were evaluated. All patients had hematological malignancy and the majority were AML (67%). Most of the baseline characteristics were comparable between the two groups including malignancy status, neutropenia status, and use of immunosuppressant medications. The duration of prophylaxis was similar in both groups, with a median of 46 days for Voriconazole treatment versus 48 days for Posaconazole treatment. There was no significant difference in breakthrough invasive fungal infection between the two groups (3% vs 0%, p=0.25). Over all adverse events were 70% in the voriconazole vs 78% in the posaconazole group p= .2. Symptomatic adverse events reported per patients were more likely to occur in patients on Voriconazole than those on Posaconazole (6% vs 0%, p=0.03). Eleven patients had to discontinue Voriconazole due to visual hallucinations (2 cases), hyperbilirubenemia (1 case), and transaminitis (8 cases) whereas 7 patients discontinued Posaconazole because of transaminitis (p = 0.46). All-cause mortality was 1% with Voriconazole and 5% with Posaconazole (p= 0.21). No death was attributed to fungal infection.

Conclusion:  This is the first prophylaxis study to compare voriconazole to posaconazole. Both agents were effective in preventing IFI in hematologic malignancy and allogeneic HSCT patients. No significant difference with regards to study-drug-related adverse events as well as all-cause mortality was noted.

Ray Hachem, MD, FIDSA1, Andrew Assaf, MD2, Yazan Numan, MD2, Pankil Shah, MD, MSPH3, Ying Jiang, MS1, Anne-Marie Chaftari, MD4 and Issam Raad, MD, FIDSA, FSHEA5, (1)University of Texas, M.D. Anderson Cancer Center, Houston, TX, (2)UT MD Anderson Cancer Center, Houston, TX, (3)The University of Texas MD Anderson Cancer Center, Houston, TX, (4)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Infectious Diseases, Infection Control & Employee Health, Houston, TX, (5)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX

Disclosures:

R. Hachem, None

A. Assaf, None

Y. Numan, None

P. Shah, None

Y. Jiang, None

A. M. Chaftari, None

I. Raad, Merck: Grant Investigator , Grant recipient
Pfizer: Speaker's Bureau , Speaker honorarium
Allergan: Grant Investigator , Grant recipient

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