Posaconazole in lung transplant recipients: use, tolerability, and efficacy

• Published in: Transplant infectious disease Vol. 18; no. 2; pp. 302 - 308
• Main Authors: Robinson, C.L., Chau, C., Yerkovich, S.T., Azzopardi, M., Hopkins, P., Chambers, D.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.04.2016; Wiley Subscription Services, Inc
• Subjects: Administration, Oral; Adult; Antifungal Agents - therapeutic use; Drug Interactions; Female; fungal infection; Humans; Immunocompromised Host; Immunosuppressive Agents - pharmacokinetics; Immunosuppressive Agents - therapeutic use; lung transplant; Lung Transplantation - adverse effects; Male; Middle Aged; Mycoses - drug therapy; posaconazole; Tacrolimus - blood; Tacrolimus - pharmacokinetics; Tacrolimus - therapeutic use; tacrolimus interaction; Triazoles - administration & dosage; Triazoles - therapeutic use; Young Adult; posaconazole; fungal infection; tacrolimus interaction; lung transplant
• DOI: 10.1111/tid.12497
• ISSN: 1398-2273

Background Fungal infection is a common cause of mortality and morbidity in lung transplant recipients (LuTR). Treatment failure to first‐line antifungals because of resistance or intolerance is an increasing problem. Posaconazole (PCZ), a triazole antifungal, is an attractive treatment option. Methods We performed a single‐center retrospective study to describe the use, tolerability, efficacy, and drug interaction effect (with tacrolimus) of PCZ oral suspension in LuTR. Results Seventy‐eight patients were treated with PCZ oral suspension for prophylaxis (n = 15), pre‐emptive treatment (n = 31), and treatment of possible (n = 7) and probable (n = 25) invasive fungal infection. A range of fungal isolates was encountered. Resolution was observed in 52.4% (probable, possible, and pre‐emptive treatment groups). Aggregate all‐cause 1‐year mortality was 12.8%. PCZ was well tolerated with 11.5% of patients experiencing adverse effects. Despite dose adjustment strategies, 11.7% of patients experienced supratherapeutic tacrolimus levels, which in 5 cases was associated with a rise (mean 21.6 μmol/L) in serum creatinine. Conclusions PCZ is well tolerated and appears effective in the management of fungal infection after lung transplantation. Patients receiving concurrent tacrolimus require careful therapeutic drug monitoring.