Evidence mapPaperPMID 42455040Full record

ArticleThe Journal of antimicrobial chemotherapy2026

Subtherapeutic posaconazole exposure during delayed-release tablet prophylaxis in high-risk patients with haematological malignancies: rationale for routine therapeutic drug monitoring.

Karen F Urbancic, Michelle K Yong, KarYee Yong, Hayley Page, Marcelle Stewart, David Ritchie, Ashish Bajel, Eric Wong, Chun Fong, Jason A Trubiano and 2 more

Abstract readMulticenter Study
In one paragraph

Article in The Journal of antimicrobial chemotherapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Karen F UrbancicPharmacy Department, Austin Health, Heidelberg, VIC, Australia.ORCID 0000-0002-9275-578X
Michelle K YongNational Centre for Infections in Cancer, National Health and Medical Research Council Centre of Research Excellence, Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC, Australia.
KarYee YongNational Centre for Infections in Cancer, National Health and Medical Research Council Centre of Research Excellence, Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC, Australia.ORCID 0009-0007-8888-1648
Hayley PageNational Centre for Infections in Cancer, National Health and Medical Research Council Centre of Research Excellence, Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC, Australia.
Marcelle StewartNational Centre for Infections in Cancer, National Health and Medical Research Council Centre of Research Excellence, Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC, Australia.
David RitchieClinical Haematology Department, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC, Australia.
Ashish BajelDepartment of Medicine, University of Melbourne, Parkville, VIC, Australia.
Eric WongDepartment of Medicine, University of Melbourne, Parkville, VIC, Australia.
Chun FongClinical Haematology Department, Austin Health, Heidelberg, VIC, Australia.
Jason A TrubianoDepartment of Infectious Diseases and Immunology, Austin Health, Heidelberg, VIC, Australia.ORCID 0000-0002-5111-6367
David C M KongCentre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia.ORCID 0000-0002-5022-9060
Monica A SlavinNational Centre for Infections in Cancer, National Health and Medical Research Council Centre of Research Excellence, Peter MacCallum Cancer Centre, Department of Oncology, University of Melbourne, Parkville, VIC, Australia.ORCID 0000-0002-8443-314X

Funding

Merck Sharp & Dohme Australia MSD-IIS-55730National Health and Medical Research Council (NHMRC) APP1133479
6 · The paper itself

Abstract

backgroundPosaconazole prophylaxis is indicated in high-risk patients with haematological malignancies to prevent invasive fungal diseases (IFDs) with guidelines advising steady-state posaconazole plasma concentrations (PPCs) above 0.5-0.7 mg/L. Therapeutic drug monitoring (TDM), however, is not routinely recommended for posaconazole delayed-release tablet (DRT) prophylaxis.

objectivesTo describe PPCs in hospitalized high-risk patients with haematological malignancies treated for AML or undergoing allogeneic haematopoietic cell transplantation receiving posaconazole prophylaxis with posaconazole DRT and factors influencing exposure. PATIENTS AND

methodsThis prospective, two-centre cohort study measured serial PPCs at Days 7, 14 and 21, and during diarrhoea episodes in adult high-risk patients receiving prophylaxis with posaconazole DRT between August 2019 and May 2023. Patients were followed during hospital admission and for 7 days after the last dose of posaconazole or hospital discharge.

resultsNinety-two patients contributed 223 PPCs. Subtherapeutic PPCs (<0.7 mg/L) occurred in 77 (34.5%) samples and 49 (53.3%) patients recorded ≥1 subtherapeutic PPC. The median Day 7 PPC was 0.84 (IQR: 0.47-1.16) mg/L, with no significant changes over time. In patients with diarrhoea compared with no diarrhoea, the median PPC was significantly lower [0.74 (IQR: 0.48-1.00) mg/L versus 0.92 (IQR: 0.64-1.40) mg/L, P = 0.007]. Multivariate analysis identified older age (>60 years) was protective against subtherapeutic PPCs. Six IFDs developed in five patients (5.4%) during follow-up and posaconazole-attributed hepatotoxicity resulted in cessation for one patient (1.1%).

conclusionsSubtherapeutic PPCs are common during posaconazole DRT prophylaxis, suggesting the need for routine TDM to optimize dosing in those receiving this posaconazole formulation.

Indexed as

Antifungal AgentsDrug MonitoringHematologic NeoplasmsInvasive Fungal InfectionsTriazolesAdultAgedDelayed-Action PreparationsFemaleHumansMaleMiddle AgedProspective StudiesTabletsAntifungal AgentsDelayed-Action PreparationsposaconazoleTabletsTriazoles

Identifiers

PMID42455040
PMCPMC13370829

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.