Trends in Triazole Therapy and Mortality Rates Among Hospitalized Chronic Pulmonary Aspergillosis Patients: A Nationwide Observational Study in France

<bold>Background:</bold> Based on the French nationwide administrative hospital database (PMSI), we previously reported the emergence and high mortality of hospitalized Chronic Pulmonary Aspergillosis (CPA) in France. Data supporting itraconazole (ITC) efficacy are limited to one short controlled trial and uncontrolled study for voriconazole (VCZ). Real life data are lacking to assess triazole efficacy in CPA <bold>Objective:</bold> This study aims to compare CPA mortality in triazole treated or untreated patients. <bold>Methods:</bold> Data were extracted from the French National Health Data System (SNDS), aggregating data from PMSI and the national health insurance database. <bold>Results:</bold> A total of 9,544 CPA patients were hospitalized for CPA in France from 2013 to 2018. The proportion of patients receiving ITC increased from 16 to 20% during this period (p<0.01). Additionally, VCZ was delivered from 2016 with the increasing proportion from 15 to 23% in 2018 (p<0.01). Globally, 1-year mortality in CPA patients decreased from 40.4% (2013-2015) to 32.6% (p<0.01) from 2016, the year of VCZ’s use approval in France. Excluding patients who died during the inclusion stay, 1-year mortality was 18.2% in 3,320 patients receiving triazole compared to 26.2% in the 4,584 untreated patients (p<0.01). <bold>Conclusion:</bold> Our study suggests the potential benefits of triazole therapy in reducing global mortality among CPA patients, based on real-world data from France. Further research is warranted to validate these findings and optimize treatment strategies for CPA management