A comparison of pasaconazol and itraconazol treatments used in antifungal prophilaxis in patients with acute myeloid leukemia in Dicle University Hospital Hematology Clinic

Objective: Invasive fungal infections (IFIs) cause serious morbidity and mortality in patients with AML receiving remission induction therapy, increasing the importance of prophylactic treatment approach. The aim of our study is to compare the effectiveness of posaconazole and itraconazole treatments used in antifungal prophylaxis in patients with AML. Materials and Methods: In our study, the data of 67 patients who received remission induction therapy with newly diagnosed AML between 2015 and 2019 at Dicle University Medical Faculty Hospital were retrospectively analyzed. 34 of these patients were included in the posaconazole group and 33 were in the itraconazole group. All patients were examined for the development of IFI. While under prophylaxis in the posaconazole and itraconazole groups, the incidence rates of developing IFI were the primary outcome, and the secondary outcome was the 30 and 100-day survival rates and the risks leading to IFI. Results: 12 (35.2%) patients in the posaconazole group and 20 (60.6%) patients in the itraconazole group were diagnosed with IFI. In the multivariate regression analysis, itraconazole used in antifungal prophylaxis significantly increased the risk of IFI compared to posaconazole (OR: 4.54, 95% CI: 1.16-17.77, p = 0.030). When the 100-day survival is compared; 5 (14.7%) patients in the posaconazole group and 14 (42.4%) patients in the itraconazole group died (p = 0.012). When the attributable mortality of IFIs is examined, the deaths of 1 (2.9%) patient in the posaconazole group and 4 (12.1%) patients in the itraconazole group were associated with IFI (p = 1,000). Conclusion: It is seen that the comparative studies of posaconazole tablet form with other antifungal agents is few in the literature. It was seen that posaconazole prophylaxis was effective in preventing IFI compared to itraconazole and it would be more beneficial to use posaconazole in AML patients under remission induction chemoterapy.