BACKGROUND: First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability. OBJECTIVES: Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment. METHODS: We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction). RESULTS: Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp]. CONCLUSIONS: Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.

Center for Integrated Oncology CIO Köln Bonn Medical Faculty University of Cologne Cologne Germany

Center for Molecular Medicine Cologne University of Cologne Cologne Germany

Center of Microbiological Research of Cesar Rosario Pumarejo de López Hospital Laura Daniela Clinic Médicos Clinic LTDA Valledupar Colombia

Clinic for Infectious and Tropical Diseases Clinical Centre of Serbia Faculty of Medicine University of Belgrade Serbia

Clinical Microbiology and Parasitology Department University Hospital La Paz Madrid Spain

Clinical Trials Centre Cologne University of Cologne Cologne Germany

Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases University of Cologne Cologne Germany

Department for Hematology Oncology and Tumorimmunology Charité University Medicine Berlin Campus Virchow Clinic Berlin Germany

Department of Clinical Microbiology Mycology and Antibiotic Therapy National Research Center for Hematology Moscow Russia

Department of Clinical Mycology Allergy and Immunology North Western State Medical University Saint Petersburg Russia

Department of Haematology and Oncology Medical Centre Otto von Guericke University Magdeburg Magdeburg Germany

Department of Infectious Diseases Royal Perth Hospital Perth WA Australia

Department of Internal Medicine 2 Julius Maximilians University Würzburg Germany

Department of Internal Medicine 3 University of Munich Munich Germany

Department of Internal Medicine Hematology and Oncology Masaryk University Brno Czech Republic

Department of Internal Medicine Infectious Diseases Goethe University Frankfurt Frankfurt am Main Germany

Department of Medicine San Diego Veterans Affairs Medical Center San Diego CA USA

Department of Oncology and Hematology Hôpitaux Universitaires de Strasbourg and Université de Strasbourg Inserm UMR S1113 IRFAC Strasbourg France

Division of Clinical Microbiology Department of Laboratory Medicine Medical University of Vienna Vienna Austria

Division of Infectious Diseases Departments of Medicine Microbiology and Immunology Research Institute of the McGill University Health Centre Montreal QC Canada

Division of Infectious Diseases University of California San Diego San Diego CA USA

German Centre for Infection Research partner site Bonn Cologne Cologne Germany

Inserm U1100 Tours University Tours France

Institute for Virology and Clinical Microbiology Witten Herdecke University Witten Germany

Parasitology Mycology and Tropical Medicine Service University Hospital of Tours Tours France

School of Pathology and Laboratory Medicine University of Western Australia Perth WA Australia

Section of Infectious Diseases and Tropical Medicine Department of Internal Medicine Medical University of Graz Graz Austria

Section of Pulmonology and Critical Care Department of Medicine Aga Khan University Hospital Karachi Pakistan

Service of Infectious Diseases Clínic Hospital University of Barcelona Institute of Biomedical Research August Pi i Sunyer Barcelona Spain

University Hospital Brno Brno Czech Republic

University of Cologne Faculty of Medicine and University Hospital of Cologne Department 1 of Internal Medicine Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf Cologne Germany

University of Cologne Institute for Medical Microbiology Immunology and Hygiene Cologne Germany

Wisplinghoff Laboratories Cologne Germany

References provided by Crossref.org