Where Are They Now? Q&A with Dr. Brian Lu

By: Cara Slaton, PharmD, BCIDP

Brian Lu, PharmD

Dr. Brian Lu is a clinical and antimicrobial stewardship pharmacist at Stanford Health Care Tri-Valley. He completed his PGY-1 residency as well as his PGY-2 residency in Infectious Diseases at Stanford Health Care. His interests include therapeutic drug monitoring, and antimicrobial resistance.

New research published in Open Forum Infectious Diseases!

Combination Antifungal Therapy for Invasive Mucormycosis in Immunocompromised Hosts: A Single-Center Experience | Open Forum Infectious Diseases | Oxford Academic (oup.com)

Dr. Lu and colleagues assessed the impact of combination antifungal therapy for invasive mucormycosis (IM) in a cohort of immunocompromised patients. Patients receiving combination therapy were categorized as either “upfront” or “salvage”, based on when combination therapy was initiated. There was no difference in 6-week mortality between upfront combination nor salvage combination antifungal therapy when compared to monotherapy.

Questions:

1. What led your group to investigate combination vs. monotherapy antifungal therapy for invasive mucormycosis? IM carries significant morbidity and mortality, particularly in immunocompromised patients who often have limited treatment options. We noticed a sizable amount of our patients receiving combination antifungal therapy for IM, despite the data being mixed in terms of clinical impact.  This provided us an opportunity to try to further elucidate any potential benefit by applying definitions for combination therapy that differed from prior studies of IM.

1. Did any of your findings surprise you? Combination therapy seemed to correlate with increased mortality in our logistic regression, although these findings were not statistically significant. We hypothesized this may be due to confounding by indication, where providers may have opted for combination therapy for patients who are at higher risk for poor outcomes.

1. How have the results of your study impacted your management of mucormycosis Surgery remains a mainstay of treatment for patients with IM, and source control should still be prioritized for those able to receive surgery. For those who are unable to achieve source control, individualized risk/benefit discussions may also be warranted, as the results of this study do not suggest a clinical benefit from combination antifungal therapy.

1. Based on your research, what are some unanswered questions that you believe should be further investigated? The management of mucormycosis has evolved over the years, which includes the antifungal agents available and their varying formulations. Comparative studies of specific antifungal regimens (monotherapy or in combination) may be helpful for identifying preferred therapies for the treatment of mucormycosis.

The MAD-ID ‘Where Are They Now?’ series highlights research presented at the MAD-ID Annual Meeting now published in the infectious diseases literature.