Dahlen, T., Kalin, M., Cederlund, K., Nordlander, A., Bjorkholm, M., Ljungman, P., & Blennow, O. (2016). Decreased invasive fungal disease but no impact on overall survival by posaconazole compared to fluconazole prophylaxis: A retrospective cohort study in patients receiving induction therapy for acute myeloid leukaemia/myelodysplastic syndromes. European Journal of Haematology, 96, 175–180.

To investigate the effects of changing from floconazole to posaconazole on the incidence of invasive fungal disease (IFD) and survival

Data were obtained from medical records for analysis. From 2008 to March 2011, primary antifungal prophylaxis was fluconazole 100–200 mg daily. In 2011, prophylaxis was changed to posaconazole 200 mg three times per day. Fungal prophylaxis in most cases was done only during neutropenia. Wards were not equipped with HEPA filters. Bacterial prophylaxis with ciprofloxacin was used during neutropenia in 80%–90% of patients. In 283 patients, comparison of results with posaconazole versus fluconazole was done.

• N = 328   
• MEDIAN AGE = 59 years
• AGE RANGE = 21–85 years
• MALES: 55.1%, FEMALES: 44.9%
• CURRENT TREATMENT: Chemotherapy, other
• KEY DISEASE CHARACTERISTICS: Eighty-seven percent had acute myeloid leukemia, 29% had allogeneic hematopoietic cell transplantation (HCT), and 43.5% had nonallogeneic HCT.

• SITE: Multi-site   
• SETTING TYPE: Not specified    
• LOCATION: Sweden

PHASE OF CARE: Active antitumor treatment

Retrospective cohort comparison

IFD was defined according to the revised 2008 European Organization for Research and Treatment of Cancer (EORTC) definitions.

The incidence of IFD was signficantly lower at day 100 and at the end of patient follow-up (p < 0.01). The incidence of aspergillosis (p = 0.01) and invasive candidiasis (p < 0.05) were also lower in those given posaconazole. Antifungal therapy was more common in the fluconazole group (p < 0.01). There was no difference in overall survival at day 100 or at the end of follow-up.

The use of posaconazole for primary antifungal prophylaxis was more effective for reduction in IFD compared to fluconazole.

• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results
• Key sample group differences that could influence results
• No subgroup analysis according to HCT type
• No information on whether colony-stimulating factors were used

Posaconazole was shown to be more effective than fluconazole for the prevention of IFD in high-risk patients; however, the retrospective nature and other design factors limit the validity of this study. A variety of research is aimed at the determination of the most effective antifungal agents for prophlyaxis. Additional research is needed to determine if specific antifungals are more effective overall.