The MDS Beacon™

Vfend (voriconazole) may be an effective alternative to Sporanox (itraconazole) in the prevention of fungal infection in myelodysplastic syndromes (MDS) according to researchers at the University of Texas MD Anderson Cancer Center.

The research results were published in the official journal of the Multinational Association of Supportive Care in Cancer.

Infections are a serious risk to MDS patients undergoing treatment. Many physicians prescribe antibiotics or antifungal treatments preemptively to prevent infections from developing during MDS treatment.

Sporanox is the traditional initial option for antifungal treatment in high-risk MDS and acute myelogenous leukemia (AML) patients. Vfend was approved to treat fungal infections in 2002, but it has not been previously tested in high-risk MDS or AML patients.

The study evaluated the efficacy and safety of antifungal prevention with Vfend or Sporanox in 123 patients, all of whom were randomly assigned one of the two drugs. Of those evaluated, 29 patients had MDS and 94 had AML as their underlying disease.

Both drugs were given intravenously. Vfend was given at 400 mg every 12 hours for two doses, followed by 300 mg every 12 hours. Sporanox was given at 200 mg twice a day for two days, followed by 200 mg once daily.

None of the patients receiving Vfend developed fungal infections, while two of the patients receiving Sporanox developed fungal infections, a rate of 4 percent. The overall response rate was comparable for the two drugs, a rate of 69 percent for Vfend and 56 percent for Sporanox.

The most common side effect for both drugs was moderate to severe liver malfunction, at a rate of 11 percent for Vfend and 9 percent for Sporanox. Visual and auditory hallucinations were also experienced by patients receiving Vfend at a rate of 10 percent. Vfend was associated with a higher rate of side effects, particularly adverse liver functions and the development of hallucinations. All side effects were resolved after the discontinuation of the study drug.

“Patients with increased bilirubin before the start of chemotherapy will have higher chances to develop side effects,” said Dr. Gloria Mattiuzzi, a researcher for the study. Bilirubin is a product of hemoglobin found in bile. Increased bilirubin levels may be an indication of liver problems.

Researchers concluded that Vfend and Sporanox are both very effective in the prevention of fungal infections in patients with high-risk MDS and AML. Due to its exceptional efficacy, Vfend was identified as a good alternative to Sporanox in preventative antifungal treatment.

For more information, please see the study in Supportive Care in Cancer (abstract).