Fungal prophylaxis with a gastro-resistant posaconazole tablet for patients with hematological malignancies in the POSANANTES study

Abstract

Posaconazole is an antifungal drug used in both prophylaxis and treatment of invasive fungal infections. Its oral formulation requires therapeutic drug monitoring. To overcome gastric acidity, a gastro-resistant posaconazole tablet has recently been developed. POSANANTES was a prospective noninterventional study that aimed to monitor plasma concentration trough level (C min ) of posaconazole tablets used prophylactically in patients with hematological malignancies. Fifty patients were included. Group A (n=31) included patients receiving induction chemotherapy for myeloid malignancies, and group B (n=19) included patients treated for graft-versus-host disease after allogeneic hematopoietic stem cells transplantation. In multivariate analysis, female sex, group B assignment, and evaluation of C min at day 8 (versus any other day planned by the analysis) were associated with a higher C min , while diarrhea was associated with a lower C min (P<0.05). Thirty-four percent (n=17) of all included patients had to prematurely stop treatment, mainly in group A. In conclusion, this real-life prospective study showed good absorption of posaconazole tablets used for prophylaxis in patients with hematological malignancies, even though this strategy was somewhat limited due to the high number of patients in group A who had to stop their treatment in an untimely fashion.