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International Journal of Clinical Oncology

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12.07.2019 | Original Article

Impact of oral voriconazole during chemotherapy for acute myeloid leukemia and myelodysplastic syndrome: a Japanese nationwide retrospective cohort study

verfasst von: Ikuyo Tsutsumi, Susumu Kunisawa, Chikashi Yoshida, Masanori Seki, Takuya Komeno, Kiyohide Fushimi, Satoshi Morita, Yuichi Imanaka

Erschienen in: International Journal of Clinical Oncology | Ausgabe 11/2019

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Abstract

Background

The prevention of invasive fungal infections is important in patients with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) receiving cytoreductive chemotherapy. However, the role of oral voriconazole (VRCZ) in such patients has not been established. This study aimed to investigate the effectiveness of oral VRCZ compared to that of first-generation azoles prescribed within 7 days after the onset of chemotherapy in adult patients with AML/MDS using the Japanese administrative database.

Methods

This nationwide retrospective cohort study was conducted using the Diagnosis Procedure Combination/Per-Diem Payment System. The primary outcome was the proportion of patients who switched to intravenous antifungal agents. Analyses using the instrumental variable method were performed to address unmeasured confounding.

Results

In total, data on 5517 inpatients from 142 hospitals were analyzed. An oral VRCZ prescription was significantly associated with a reduction in the proportion of patients switching to intravenous antifungal agents compared to first-generation azole prescription (21.0% (95% confidence interval [CI] − 33.4 to − 8.6)). The impact of oral VRCZ in reducing the proportion of patients switching to intravenous antifungal agents was stronger in patients aged < 65 years than in those aged ≥ 65 years (− 40.6%, 95% CI − 63.2 to − 17.9; − 21.9%, 95% CI − 35.8 to − 8.1, respectively) and in patients prescribed oral azole within 3 days from the onset of chemotherapy than in those prescribed the same later (− 32.9%, 95% CI − 46.7 to − 19.2; − 9.0%, 95% CI − 33.7 to 15.7, respectively).

Conclusion

Oral VRCZ administration may benefit adult patients with AML/MDS undergoing chemotherapy.

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Titel: Impact of oral voriconazole during chemotherapy for acute myeloid leukemia and myelodysplastic syndrome: a Japanese nationwide retrospective cohort study
verfasst von: Ikuyo Tsutsumi
Susumu Kunisawa
Chikashi Yoshida
Masanori Seki
Takuya Komeno
Kiyohide Fushimi
Satoshi Morita
Yuichi Imanaka
Publikationsdatum: 12.07.2019
Verlag: Springer Singapore
Erschienen in: International Journal of Clinical Oncology / Ausgabe 11/2019
Print ISSN: 1341-9625
Elektronische ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-019-01506-x

Springer Medizin

Impact of oral voriconazole during chemotherapy for acute myeloid leukemia and myelodysplastic syndrome: a Japanese nationwide retrospective cohort study