中止
医学
不利影响
挽救疗法
曲菌病
毛霉病
内科学
棘白菌素
外科
移植
耐火材料(行星科学)
回顾性队列研究
他克莫司
化疗
抗真菌
氟康唑
免疫学
皮肤病科
物理
天体生物学
作者
Mario Fernández‐Ruiz,Marta Bodro,Isabel Gutiérrez Martín,Regino Rodríguez-Álvarez,María Ruiz-Ruigómez,Núria Sabé,Teresa López-Viñau,Maricela Valerio,Aitziber Illaro,Jesús Fortün,Sonsoles Salto‐Alejandre,Elisa Cordero,María del Carmen Fariñas,Patricia Muñóz,Elisa Vidal,Jordi Carratalà,Josune Goikoetxea,Antonio Ramos‐Martínez,Asunción Moreno,José María Aguado
出处
期刊:Transplantation
[Ovid Technologies (Wolters Kluwer)]
日期:2022-10-20
卷期号:107 (3): 762-773
被引量:5
标识
DOI:10.1097/tp.0000000000004312
摘要
Isavuconazole has theoretical advantages over other mold-active triazoles for the treatment of invasive aspergillosis and mucormycosis after solid organ transplantation (SOT). The available clinical experience, nevertheless, is scarce.We performed a retrospective study including all adult SOT recipients with proven or probable invasive mold disease (IMD) that received isavuconazole for ≥24 h as first-line or salvage therapy at 10 Spanish centers between September 2017 and November 2021. The primary efficacy outcome was clinical response (complete or partial resolution of attributable symptoms and findings) by weeks 6 and 12. Safety outcomes included the rates of treatment-emergent adverse events and premature isavuconazole discontinuation.We included 81 SOT recipients that received isavuconazole for a median of 58.0 days because of invasive aspergillosis (n = 71) or mucormycosis (n = 10). Isavuconazole was used as first-line (72.8%) or salvage therapy due because of previous treatment-emergent toxicity (11.1%) or refractory IMD (7.4%). Combination therapy was common (37.0%), mainly with an echinocandin or liposomal amphotericin B. Clinical response by weeks 6 and 12 was achieved in 53.1% and 54.3% of patients, respectively, and was more likely when isavuconazole was administered as first-line single-agent therapy. At least 1 treatment-emergent adverse event occurred in 17.3% of patients, and 6.2% required premature discontinuation. Daily tacrolimus dose was reduced in two-thirds of patients by a median of 50.0%, although tacrolimus levels remained stable throughout the first month of therapy.Isavuconazole is a safe therapeutic option for IMD in SOT recipients, with efficacy comparable to other patient groups.
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