Evaluation of Posaconazole in Treatment of Severe Coccidioidomycosis
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Coccidioidomycosis affected more than 150,000 people in United States. Most cases of coccidioidomycosis are self limiting and confined to the lungs. In severe cases, the disease can disseminate the the bone, soft tissues, and central nervous system. Management of severe coccidioidomycosis is challenged by high rates of recurrences and refractory cases. Galgiani and colleagues had shown posaconazole to be effective in refractory cases. To the best of our knowledge, no study has compared the effectiveness of posaconazole to fluconazole. Methods. IRB approved retrospective chart review was conducted looking at patients taking posaconazole and fluconazole from January 2013 to January 2014. Patients over 18 years of age with severe coccidioidomycosis were included. Patients without miliary or extra pulmonary dissemination were excluded. Efficacy was assessed using the Mycosis Study Group (MSG) score. Primary outcome was defined as the number of patients with greater than 50% decrease in MSG score. Secondary outcomes were number of patients with no change or less than 25% change in MSG score, overall change in MSG score and improvement in coccidioides complement fixation (CF) titers. Statistical analysis was conducted using Stata version 12. Wilcoxon rank-sum test was used for continuous data. Fischer's Exact test was used for discrete data. Results. Forty-six patients were included in the study. Twenty-three patients were taking posaconazole and 23 patients were taking fluconazole for severe coccidioidomycosis. Seventy-eight percent of patients in posaconazole group and 83% of patients in fluconazole group had greater than 50% decrease in MSG score (p = 0.81). There was no statistically significant differences between the two groups. Twenty-two percent and 17% of patients in posaconazole and fluconazole group, respectively, have no change or less than 25% change in MSG score (p = 0.777). Overall change in MSG score was 8 for posaconazole and 5 for fluconazole (p = 0.01). Greater than 75% of patients in both group have decrease in coccidioides CF titers. Conclusion. Posaconazole is an effective treatment option for severe coccidioidomycosis. Its efficacy is similar to fluconazole. It can be used in patients with more severe disease and higher MSG score at diagnosis. It can be used in patients refractory to standard treatment and in those who need oral maintenance therapy. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2344990383