Impact of oral voriconazole during chemotherapy for acute myeloid leukemia and myelodysplastic syndrome: a Japanese nationwide retrospective cohort study
The prevention of invasive fungal infections is important in patients with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) receiving cytoreductive chemotherapy. However, the role of oral voriconazole (VRCZ) in such patients has not been established. This study aimed to investigate the effectiveness of oral VRCZ compared to that of first-generation azoles prescribed within 7 days after the onset of chemotherapy in adult patients with AML/MDS using the Japanese administrative database.
This nationwide retrospective cohort study was conducted using the Diagnosis Procedure Combination/Per-Diem Payment System. The primary outcome was the proportion of patients who switched to intravenous antifungal agents. Analyses using the instrumental variable method were performed to address unmeasured confounding.
In total, data on 5517 inpatients from 142 hospitals were analyzed. An oral VRCZ prescription was significantly associated with a reduction in the proportion of patients switching to intravenous antifungal agents compared to first-generation azole prescription (21.0% (95% confidence interval [CI] − 33.4 to − 8.6)). The impact of oral VRCZ in reducing the proportion of patients switching to intravenous antifungal agents was stronger in patients aged < 65 years than in those aged ≥ 65 years (− 40.6%, 95% CI − 63.2 to − 17.9; − 21.9%, 95% CI − 35.8 to − 8.1, respectively) and in patients prescribed oral azole within 3 days from the onset of chemotherapy than in those prescribed the same later (− 32.9%, 95% CI − 46.7 to − 19.2; − 9.0%, 95% CI − 33.7 to 15.7, respectively).
Oral VRCZ administration may benefit adult patients with AML/MDS undergoing chemotherapy.
KeywordsInvasive fungal infections Acute myeloid leukemia Myelodysplastic syndrome Cytoreductive chemotherapy Oral voriconazole
The authors thank Editage by CACTUS (Tokyo, Japan) for proofreading our manuscript. This study was supported in part by a Grant-in-aid for Scientific Research from the Japan Society for the Promotion of Science (A) (16H02634). All the authors had full access to all the data in this study and take complete responsibility for the integrity of data and accuracy of the data analysis.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
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