Efficacy and Safety of Voriconazole Versus Amphotericin B Deoxycholate Induction Treatment for HIV-Associated Talaromycosis: A Prospective Multicenter Cohort Study in China

Zhou, Yihong; Qin, Yuanyuan; Lu, Yanqiu; Yuan, Jing; Nie, Jingmin; Liu, Min; Tian, Qun; Lan, Ke; Zhou, Guoqiang; Qin, Yingmei; He, Kaiyin; Yu, Jianhua; Jiang, Zhuocheng; Li, Jun; Liu, Shuiqing; Harypursat, Vijay; Chen, Yaokai

doi:10.1007/s40121-022-00658-0

Cited by 6 publications

(9 citation statements)

References 15 publications

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“…There have been reports using voriconazole or fluconazole for treatment with success although higher MIC values have been reported and seem to correlate with delayed blood culture clearance with these agents [77,78]. Further, in an open label, nonrandomized trial comparing AmBD and voriconazole among 410 patients with disseminated talaromycosis ( n = 269 AmBD, n = 141 voriconazole), although there was no difference in mortality, there was improved clinical resolution and fungal clearance among those who received AmB [79]. The same outcome pattern was seen in logistic regression of matched cohorts (n = 122 each arm) [79].…”

Section: Talaromycosismentioning

confidence: 99%

“…Further, in an open label, nonrandomized trial comparing AmBD and voriconazole among 410 patients with disseminated talaromycosis ( n = 269 AmBD, n = 141 voriconazole), although there was no difference in mortality, there was improved clinical resolution and fungal clearance among those who received AmB [79]. The same outcome pattern was seen in logistic regression of matched cohorts (n = 122 each arm) [79]. The use of posaconazole and isavuconazole have each been reported in one case [80].…”

Section: Talaromycosismentioning

confidence: 99%

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Endemic mycoses – are we making progress in management?

Bahr,

Thompson

2023

Current Opinion in Infectious Diseases

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Purpose of review The endemic fungi are a significant cause of morbidity and mortality in effected patients. The range of endemicity for these are expanding with infections observed outside of traditional locations. Enhanced diagnostic and treatment practices may significantly alter patient outcomes. Recent findings Recently completed clinical trials have focused on an assessment of improving efficacy while minimizing patient toxicity. Practice changing trials have been completed in histoplasmosis showing the utility of a single up-front liposomal amphotericin B dose followed by standard itraconazole dosing. The recent evaluation of several antifungal options including isauvconazole in the treatment of coccidioidomycosis also show promise for additional therapeutic agents. A recently conducted trial has also shown the superiority of amphotericin B therapy over itraconazole in the treatment of talaromycosis. Summary The increased range of endemic mycoses coupled with the growing immunocompromised patient population mandates continued investigation of improved diagnostic and therapeutic options. Advances in these areas have led to more rapid diagnosis and more efficacious antifungal therapy.

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Section: Talaromycosismentioning

confidence: 99%

Section: Talaromycosismentioning

confidence: 99%

Endemic mycoses – are we making progress in management?

Bahr,

Thompson

2023

Current Opinion in Infectious Diseases

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“…[9] Voriconazole had been proven to be an effective, welltolerated treatment option for talaromycosis. [26][27][28] In a prospective multicenter cohort study, 410 HIV-infected patients diagnosed with talaromycosis received induction treatment with either amphotericin B deoxycholate intravenously or voriconazole. In terms of all-cause mortality rate, induction therapy using voriconazole had a similar efficacy with amphotericin B deoxycholate in HIV-infected patients with talaromycosis.…”

mentioning

confidence: 99%

“…In terms of all-cause mortality rate, induction therapy using voriconazole had a similar efficacy with amphotericin B deoxycholate in HIV-infected patients with talaromycosis. [27] Moreover, another retrospective study from Guangxi, China, indicated that voriconazole is an effective and safe induction antifungal drug for HIV-associated disseminated talaromycosis. [28] Most guidelines recommended that antiviral treatment (ART) should be initiated within 1 to 2 weeks after effective antifungal treatment for talaromycosis, with weak evidences.…”

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Advances in diagnosis and treatment of talaromycosis in patients with AIDS

Guo

Tang

2022

Chinese Medical Journal

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Voriconazole trough concentration and clinical outcomes in patients with Talaromycosis

Zhiwen,

Cong,

Bingkun

et al. 2023

Preprint

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Background: Voriconazole (VRC) has been used as an alternative regimen for the treatment of talaromycosis. This study first analyzed the correlation between the VRC trough concentration and clinical outcomes. Methods: We prospectively enrolled patients diagnosed with talaromycosis who received VRC as induction therapy. Clinical information was collected for study analysis. Results: This study included 76 patients diagnosed with talaromycosis from October 2019 to June 2022. The results showed that 62 patients had clinical remission, and 5 patients died of talaromycosis. The overall effective rate of VRC was 89.9%. The incidence of treatment-related adverse events (AEs) was 17.4%, mainly including neurotoxicity and hypokalemia. The range of the initial VRC trough concentration was 0.23-16.95 μg/mL, indicating a large variability. No correlation was found between the VRC trough concentration and treatment failure. The mortality rate significantly increases when the patient's APSCHE II score > 10. The trough concentration threshold for AEs of VRC is 5.4 μg/mL. Conclusion: Voriconazole is an effective antifungal drug for the treatment of talaromycosis in patients with APACHE II scores < 10. Routine TDM may improve the management of treatment-related adverse events.

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Efficacy and Safety of Voriconazole Versus Amphotericin B Deoxycholate Induction Treatment for HIV-Associated Talaromycosis: A Prospective Multicenter Cohort Study in China

Cited by 6 publications

References 15 publications

Endemic mycoses – are we making progress in management?

Endemic mycoses – are we making progress in management?

Advances in diagnosis and treatment of talaromycosis in patients with AIDS

Voriconazole trough concentration and clinical outcomes in patients with Talaromycosis

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