Posaconazole is used for prophylaxis for invasive fungal infections (IFIs) among patients with hematologic malignancies. We compared incidence of breakthrough IFI and early discontinuation between patients receiving delayed-release tablet and oral suspension formulations of posaconazole. This was a retrospective cohort study of patients receiving posaconazole between 1/1/2010 and 6/30/2016. We defined probable or proven breakthrough IFI using the European Organization for Research and Treatment of Cancer (EORTC) criteria. Overall, 547 patients received 860 courses of posaconazole (53% oral suspension and 48% tablet); primary indications for prophylaxis were acute myeloid leukemia (69%), graft versus host disease (18%), and myelodysplastic syndrome (3%). There were no significant differences in demographics or indication between patients receiving the different formulations. Incidence and incidence rate of probable or proven IFI were 1.6% or 3.2 per 10,000 posaconazole days. There was no significant difference in the rate of IFI between suspension courses (2.8 per 10,000 posaconazole days) and tablet courses (3.7 per 10,000 posaconazole days) (rate ratio: 0.8, 95% CI: 0.3 to 2.3). Of the 14 proven or probable cases of IFI, 8/14 had posaconazole serum concentrations measured and 7/8 were above 0.7 mcg/mL. Posaconazole was discontinued early in 15.5% of courses; however the frequency of discontinuation was also not significantly different between the tablet (16.5%) and oral suspension (14.6%) formulations (95% CI for difference: -0.13 to 0.06). In conclusion, incidence of breakthrough IFI was low among patients receiving posaconazole prophylaxis, and not significantly different between patients receiving the tablet versus oral suspension formulations.
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