Abstract
To investigate associations of the duration of voriconazole treatment and radiological response with relapse of invasive pulmonary aspergillosis (IPA) in immunocompromised patients, we explored the risk factors for IPA relapse after successful initial treatment. All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography. Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P = 0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P = 0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Longer duration of therapy should be considered for those at higher risk of relapse.
Highlights
To investigate associations of the duration of voriconazole treatment and radiological response with relapse of invasive pulmonary aspergillosis (IPA) in immunocompromised patients, we explored the risk factors for IPA relapse after successful initial treatment
Immunocompromised patients with prolonged neutropenia or taking corticosteroids, and those who received allogeneic hematopoietic stem cell transplantation (HCT) or solid-organ transplantation, and with severe influenza are at high risk of I PA3,4
Insufficient treatment may result in relapse of IPA, which would lead to the increased morbidity and mortality
Summary
To investigate associations of the duration of voriconazole treatment and radiological response with relapse of invasive pulmonary aspergillosis (IPA) in immunocompromised patients, we explored the risk factors for IPA relapse after successful initial treatment. We hypothesized that short course of voriconazole treatment, defined empirically as less than 9 weeks (i.e., median of the commonly recommended duration by the Infectious Disease Society of A merica3), is associated with relapse of IPA. In this retrospective cohort study from a single tertiary medical centre, we analyzed the association between the short treatment duration and relapse of IPA in immunocompromised patients after adjusting for the important clinical confounders using a regression analysis. We investigated whether the radiological response at the time of treatment termination was associated with relapse of the disease
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