2018 Research Forum

Table 2

First Recorded MSG Score (Median, IQR)

Initiation of Refractory Tx MSG Score (Median, IQR)

Last Visit MSG Score (Median, IQR)

Change

Overall Improved

Lungs Isavuconazole 5 (4.5-6)

4 (4,7)

2 (1-2) 2 (2,2)

2 (2-6)

100% 100%

Posaconazole Suspension Posaconazole Tablet

9 (8-10)

6 (4.5-7.5)

4 (2.5-5.5)

8 (5.75-9.75)

5.5 (2.25-8.75) 1 (0.75-1.5)

3.5 (1.5-6.25) 75%

Skin or Soft Tissue Isavuconazole 7.5 (5.75-9.25) 5 (4-6)

2 (2,2) 4 (3-5)

3 (2-4) 4 (4-4)

100% 100%

Posaconazole Suspension Posaconazole Tablet

6 (6-6)

8 (7-9)

4 (4,4)

4.5 (4-6)

2.5 (2-3)

2.5 (1.75-3.75) 100%

Bone Isavuconazole 8.5 (7.75-0.25) 6.5 (5.5-7.25)

2 (2-2)

3.5 (2-5.25)

100% 83.3%

Posaconazole Suspension Posaconazole Tablet

9 (9-10)

7.5 (6.25-8)

1 (1-3.25)

5.5 (2-6)

7 (5-8)

5 (4-5)

1 (1-2)

2 (2-3)

77.7%

CNS Isavuconazole 6 (3.75-7.5)

4.5(2.5-5)

3 (1.25-4.75)

0 (0-2.25)

33.3%

Posaconazole Suspension Posaconazole Tablet

1 (1-1)

2 .5 (1.75-3.25) 0.5 (0.25-.75)

2 (1-3)

50%

3 (2.5-3.5)

4 (2-6)

1 (0.5,1.5)

3 (1.5-4.5)

50%

DISCUSSION Overall, favorable outcomes were seen in patients treated with isavuconazole and posaconazole with statistically significant reductions in overall MSG severity scores seen with each agent. Posaconazole showed similar efficacy to a previous study, in which posaconazole had 78% improved outcome. Overall skin and soft tissue coccidioidomycosis was associated with the best improvement; 100% improved. Pulmonary disease had 8 out of 9 improved. Bone had three patients who were stable. CNS was associated with the least improvement. 6 out of 10 CNS patients were stable. Two patients started with MSG score of 0. The remaining two patients had MSG score of 1 and 2 with CSF titer <1/2. This study had limitations of being a single center study and being retrospective in nature, making the application of points to arrive at MSG score difficult due to variable documentation of symptoms and timing of laboratory studies. Since there was a lack of medication washout, there is a potential for clinical improvement to be a result of the prior treatment rather than second. CONCLUSIONS Posaconazole and isavuconazole are reasonable options for treatment of severe coccidioidomycosis refractory to standard treatment. Prospective comparative trials are required to provide further insights into their efficacy and utility.

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