633. Safety of Foscarnet (FOS) Treatment for Human Herpesviruses (HHV) in a Contemporary Cohort of Iimmunocompromised Patients
Session: Poster Abstract Session: Oh, Those Pesky Viruses!
Thursday, October 27, 2016
Room: Poster Hall
Background: FOS is usually reserved for treatment of HHV diseases in immunocompromised patients. FOS has been reported to cause temporary renal impairment in up to 12% and acute kidney injury (AKI) in 1%- 5% of patients. We evaluated the incidence of FOS-associated nephrotoxicity in a population of immunocompromised patients with hematological malignances, stem cell transplantation (SCT) and solid organ transplantation (SOT).

Methods: We collected data on all patients treated with FOS from 5/2011–5/2015, including demographics, clinical indication, adverse events, nephrotoxicity, as defined by the RIFLE criteria (risk, injury, failure, loss, end-stage kidney disease), and outcomes at BWH/DFCI.

Results: 63 patients received FOS for treatment of HHV diseases. Median age was 58 years (range, 21-75) and 39 (62%) were male. 56 (89%) had an underlying malignancy, of these 51 (81%) had underdone SCT. Among the remaining patients; 4 (6%) had received a SOT, and 3 (5%) had HIV. FOS was used for HHV6 encephalitis (20, 32%), resistant CMV (19, 30%), resistant HSV (8, 13%), resistant VZV (5, 8%), and empirically for suspected HHV infections in (11, 17%). The median initial and final daily FOS doses were 131 (range, 33.6-180) mg/kg/day and 125 (range, 35-180) mg/kg/day, respectively. The median duration of therapy was 7 days (IQR, 4-15; range, 0-96). Nephrotoxicity was observed in 20 (31.7%) patients; the median time to onset of nephrotoxicity was 8.5 days (IQR, 5.5-15; range, 1-54). According to RIFLE criteria 5 (7.9%) developed risk, 12 (19%) had failure, and 3 (4.8%) exhibited loss of renal function. 62 (98%) patients were on ≥1 concomitantly administered nephrotoxic agent. The risk of FOS-associated nephrotoxicity was lower in SCT patients (OR 0.64; 95%CI, 0.17–2.33). The most frequent electrolyte disturbance requiring repletion was hypocalcemia 58 (92%). Blood viral clearance was observed in 45 (71%) patients. All cause in-hospital mortality was observed in 11 (17%).

Conclusion: The incidence of foscarnet-associated nephrotoxicity may be higher than previously reported in immunocompromised patients; this agent should be used with caution for treatment of resistant HHV infections.

Duaa Alsulaiman, PharmD1, David W. Kubiak, PharmD, BCPS2, Anne Mcdonnell, PharmD, BCOP1 and Francisco M. Marty, MD, FIDSA3, (1)Brigham and Women’s Hospital, Boston, MA, (2)Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, (3)Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA

Disclosures:

D. Alsulaiman, None

D. W. Kubiak, None

A. Mcdonnell, Clarion Health Care: Consultant , Consulting fee

F. M. Marty, None

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