Real-world Prescribing Patterns of Antifungal drugs in Patients with Aspergillosis

Aspergillosis is a fungal infection caused by Aspergillus that is found worldwide. Aspergillus species are saprophytic filamentous fungi living in a wide variety of environments, including soil, decaying vegetation, and dust suspended in air. 1-3) Globally, approximately 250,000 cases of invasive aspergillosis (IA) and 3,000,000 cases of chronic pulmonary aspergillosis (CPA) occur annually, 4) with Aspergillus fumigatus being the most common cause of human Aspergillus infections. 3) A. fumigatus sporulates abundantly with conidial heads, each of which produces thousands of conidia that are released into the atmosphere. The diameter of the conidia is small enough (2 to 3 µm) to reach lung alveoli. In immunocompetent individuals, ABSTRACT Background: Globally, the number of patients with aspergillosis is increasing, and the mortality rate remains high. This study aimed to investigate prescribing patterns of antifungal drugs for patients with aspergillosis in South Korea using real-world data. Methods: This retrospective cross-sectional study was performed using National Patient Sample (NPS) data collected by the Health Insurance Review and Assessment Service (HIRA) during 2011-2020. The use of antifungal drugs in patients with aspergillosis was investigated. Results: A total of 1374 patients were identified: 333 patients with invasive pulmonary aspergillosis (IPA) (24.2%), 436 patients with other PA (31.7%), 73 patients with other forms of aspergillosis (5.3%), and 532 patients with unspecified aspergillosis (38.7%). The odds of receiving an antifungal prescription were higher for IPA than for other PA (aOR, 0.233; p <0.001), and higher for hematologic malignancies than for respiratory disorders other than cancer or infections (aOR, 10.018; p <0.001). During each hospitalization period, 56.1% (97/173) and 6.4% (11/173) of IPA hospitalizations received voriconazole and itraconazole monotherapy, respectively, whereas 44.3% (27/61) and 27.9% (17/61) of other PA hospitalizations received itraconazole and voriconazole monotherapy, respectively. Among outpatients with IPA, 67.5% (85/126) and 26.2% (33/126) received voriconazole and itraconazole alone, respectively, whereas among outpatients with other PA, 86.1% (68/79) and 12.7% (10/79) received itraconazole and voriconazole alone, respectively, during the year. Conclusion: In Korea, voriconazole monotherapy was preferred in IPA inpatients, and itraconazole monotherapy was preferred in other PA inpatients. In the ambulatory care settings for IPA and other PA, itraconazole monotherapy was preferred.