Low dose posaconazole delayed release tablets for fungal prophylaxis in lung transplant recipients.

Abstract

In November 2013, posaconazole delayed release (DR) tablets were approved by the FDA with the labeled dose of 300mg daily for fungal prophylaxis. There are no studies demonstrating the appropriate dose in lung transplant recipients (LTR). We performed a 2-center retrospective cohort study of LTR taking posaconazole DR tablets for prophylaxis between January 2014 and January 2017. Mean serum trough concentrations and percentage of measurements ≥0.7mcg/mL were compared by daily dose. Forty-nine subjects with 156 steady state serum posaconazole concentrations were included. There was a significant difference in percentage of first measured concentration ≥0.7mcg/mL by initial daily dose (P=.04). The mean serum posaconazole concentration by dose was 0.9 (±0.42)mcg/mL for 100mg daily, 1.66 (±0.91)mcg/mL for 200mg daily, 2.39 (±1.49)mcg/mL for 300mg daily, and 1.75 (±0.21)mcg/mL for 400mg daily (P<.001). Mean concentrations were at goal in 63.3%, 96.9%, 94.9%, and 100% of subjects taking 100mg, 200mg, 300mg, and 400mg daily respectively (P=.04). Our results suggest that doses less than 300mg daily of posaconazole DR tablets may be adequate to achieve target serum concentrations in LTR. Larger studies are needed to confirm these findings.