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Antimicrobial Agents and Chemotherapy, February 2006, p. 658-666, Vol. 50, No. 2
0066-4804/06/$08.00+0     doi:10.1128/AAC.50.2.658-666.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Pharmacokinetics, Safety, and Efficacy of Posaconazole in Patients with Persistent Febrile Neutropenia or Refractory Invasive Fungal Infection

A. J. Ullmann,1* O. A. Cornely,2 A. Burchardt,1 R. Hachem,3 D. P. Kontoyiannis,3 K. Töpelt,2 R. Courtney,4,{dagger} D. Wexler,4 G. Krishna,4 M. Martinho,4 G. Corcoran,4,{ddagger} and I. Raad3

Third Medical Department, Johannes Gutenberg-University, Mainz, Germany,1 University of Köln, Köln, Germany,2 The University of Texas MD Anderson Cancer Center, Houston, Texas,3 Schering-Plough Research Institute, Kenilworth, New Jersey4

Received 13 May 2005/ Returned for modification 18 June 2005/ Accepted 18 November 2005

The pharmacokinetic profiles, safety, and efficacies of different dosing schedules of posaconazole oral suspension in patients with possible, probable, and proven refractory invasive fungal infection (rIFI) or febrile neutropenia (FN) were evaluated in a multicenter, open-label, parallel-group study. Sixty-six patients with FN and 32 patients with rIFI were randomly assigned to one of three posaconazole regimens: 200 mg four times a day (q.i.d.) for nine doses, followed by 400 mg twice a day (b.i.d.); 400 mg q.i.d. for nine doses, followed by 600 mg b.i.d.; or 800 mg b.i.d. for five doses, followed by 800 mg once a day (q.d.). Therapy was continued for up to 6 months in patients with rIFI or until neutrophil recovery occurred in patients with FN. The 400-mg-b.i.d. dose provided the highest overall mean exposure, with 135% (P = 0.0004) and 182% (P < 0.0001) greater exposure than the 600-mg-b.i.d. and 800-mg-q.d. doses, respectively. However, exposure in allogeneic bone marrow transplant (BMT) recipients (n = 12) was 52% lower than in non-BMT patients. Treatment-related adverse events (occurring in 24% of patients) were mostly gastrointestinal in nature. Twenty-four percent of patients had adverse events leading to premature discontinuation (none were treatment related). In efficacy-evaluable patients, successful clinical response was observed in 43% with rIFI (56% of patients receiving 400 mg b.i.d., 17% receiving 600 mg b.i.d., and 50% receiving 800 mg q.d.) and 77% with FN (74% receiving 400 mg b.i.d., 78% receiving 600 mg b.i.d., and 81% receiving 800 mg q.d.). Posaconazole is well tolerated and absorbed. Divided doses of 800 mg (400 mg b.i.d.) provide the greatest posaconazole exposure.

* Corresponding author. Mailing address: III Medizinische Klinik und Poliklinik der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55101 Mainz, Germany. Phone: 49 6131 17 6564. Fax: 49 6131 17 476564. E-mail: a.ullmann{at}3-med.klinik.uni-mainz.de.

{dagger} Present address: Pfizer, San Diego, CA.

{ddagger} Present address: Stiefel, Miami, FL.

Antimicrobial Agents and Chemotherapy, February 2006, p. 658-666, Vol. 50, No. 2
0066-4804/06/$08.00+0     doi:10.1128/AAC.50.2.658-666.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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