Voriconazole prophylaxis proven safe, effective in leukaemic patients with fungal infections

Prophylaxis treatment with voriconazole appears to be safe and effective, with an efficacy comparable to literature data for risk of invasive fungal infection with posaconazole antifungal prophylaxis, in patients with acute leukaemia undergoing chemotherapy, reports a study.

In addition, voriconazole prophylaxis appears to represent a significant cost advantage.

The investigators performed a retrospective chart review on inpatients at Sunnybrook Health Sciences Centre in Toronto, Canada, between 2005 and 2017. They compared hospitalized adult acute leukaemia patients who received voriconazole prophylaxis (cases) to patients treated with fluconazole or no prophylaxis during chemotherapy (controls).

Statistical analyses were conducted to compare baseline characteristics, safety, and efficacy outcomes between the study cohorts. In addition, the investigators compared a literature-based weighted mean risk to the voriconazole risk of invasive fungal infection identified in this study.

A total of 490 acute myeloid leukaemia or acute lymphoblastic leukaemia patients were identified, of whom 92 cases and 83 controls met the eligibility criteria. Case patients received voriconazole prophylaxis for an average of 24.4±10.8 days.

Voriconazole resulted in a lower incidence of proven or probable invasive fungal infections compared with the control treatment (3.3 percent vs 7.2 percent; p>0.05). Such finding was comparable to the literature-reported weighted incidence of invasive fungal infection with posaconazole (2.4±2.1 percent, 95 percent confidence interval, 1.3–3.4 percent; p>0.05).

Of note, voriconazole was well tolerated by most patients (91 percent). Seven patients, however, discontinued treatment as a result of asymptomatic elevated liver function tests.

“Invasive fungal infections commonly occur in acute myeloid and lymphoblastic leukaemia patients receiving chemotherapy,” the investigators said. “In these patients with acute leukaemia, posaconazole prophylaxis is [usually] recommended.”