Comparing Efficacy and Safety of Itraconazole Solution versus Posaconazole for Antifungal Prophylaxis after Heart Transplant

Abstract Background Posaconazole and itraconazole are two oral agents that are commonly prescribed for heart transplant recipients requiring aspergillus prophylaxis; however, there is limited data comparing their efficacy and tolerability. Methods This was a single-center, retrospective cohort study comparing itraconazole and posaconazole for the prevention of invasive fungal infections in heart transplant recipients between January 2015 and May 2022. The primary efficacy outcome was incidence of fungal infection. The primary safety outcome was incidence of hepatic dysfunction after initiation of therapy. Standard duration of prophylaxis therapy was 3 months for both cohorts. Results 134 patients received itraconazole prophylaxis and 98 received posaconazole prophylaxis. Patients receiving itraconazole were more likely to have received induction immunosuppression (p<0.001) and more likely to have received a heart-kidney transplant, but other baseline characteristics were similar. Patients receiving itraconazole prophylaxis had a higher rate of fungal infection (7.4% vs. 0% p=0.0065) and were more likely to have therapy changed to an alternative antifungal (20.9% vs. 10.2% p=0.03). Adverse events were similar between cohorts. Conclusion Posaconazole prophylaxis after heart transplant was associated with a lower rate of fungal infections and reduced need to change to alternative therapy when compared to itraconazole.