From the Guidelines
The recommended duration of therapy for posaconazole in treating pulmonary aspergillosis is typically 6 to 12 months, with the exact length depending on the severity of infection, patient's immune status, and clinical response. Treatment should continue until there is resolution of clinical signs and symptoms, along with radiographic improvement. For immunocompromised patients, therapy often extends toward the longer end of this range or until the underlying immunosuppression resolves. Posaconazole is usually administered as a delayed-release tablet at 300 mg twice daily on the first day, followed by 300 mg once daily thereafter, as indicated in the guidelines for prophylaxis against invasive aspergillosis 1. The medication should be taken with food to enhance absorption. Regular monitoring of liver function tests is necessary during treatment, and therapeutic drug monitoring is recommended to ensure adequate serum concentrations.
Key considerations in the treatment of pulmonary aspergillosis include:
- Controlling the underlying condition
- Surgical debridement of infected tissue when feasible
- Maintaining adequate drug levels throughout the treatment course
- Posaconazole's effectiveness against Aspergillus species due to its ability to inhibit ergosterol synthesis, which is essential for fungal cell membrane integrity. The guidelines from 2016 provide the most recent recommendations for the treatment of aspergillosis, including the use of posaconazole as an alternative therapy for invasive pulmonary aspergillosis 1.
In terms of specific treatment duration, the guidelines suggest that treatment should be continued for a minimum of 6–12 weeks, with longer durations for immunosuppressed patients until lesions have resolved and immunosuppression has been addressed 1. However, the most recent and highest quality study, which is the 2016 update by the Infectious Diseases Society of America, does not provide a specific duration for posaconazole therapy in pulmonary aspergillosis but emphasizes the importance of individualized treatment based on clinical response and patient factors 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recommended Duration of Therapy
The recommended duration of therapy for posaconazole in the treatment of pulmonary aspergillosis is not explicitly stated in the provided studies. However, some studies provide information on the treatment duration and outcomes:
- A study published in 2018 2 reported that patients who met predefined criteria for improvement at 4 and 6 months continued posaconazole long-term.
- A study published in 2010 3 reported that response to posaconazole was observed in 61% of patients at 6 months and in 46% at 12 months, with some patients responding only after approximately 1 year of therapy.
- A study published in 2021 4 reported that posaconazole was administered for 12 weeks or less in the primary treatment of invasive aspergillosis.
Key Findings
Some key findings related to the treatment duration and outcomes are:
- Posaconazole is a safe and partially effective treatment for chronic pulmonary aspergillosis 3.
- Posaconazole is non-inferior to voriconazole for all-cause mortality up until day 42 in participants with invasive aspergillosis 4.
- The efficacy of second-generation triazole antifungal drugs, including posaconazole, is comparable with liposomal amphotericin B and is better than both amphotericin B deoxycholate and amphotericin B colloidal dispersion 5.
Treatment Outcomes
The treatment outcomes for posaconazole in pulmonary aspergillosis are: