@article{HeimannPenackHeinzetal.2019,
  author    = {Heimann, Sebastian M. and Penack, Olaf and Heinz, Werner J. and Rachow, Tobias and Egerer, Gerlinde and Kessel, Johanna and Claßen, Annika Y. and Vehreschild, J{\"o}rg Janne},
  title     = {Intravenous and tablet formulation of posaconazole in antifungal therapy and prophylaxis: A retrospective, non-interventional, multicenter analysis of hematological patients treated in tertiary-care hospitals},
  series = {International Journal of Infectious Diseases},
  volume    = {83},
  journal   = {International Journal of Infectious Diseases},
  doi       = {10.1016/j.ijid.2019.04.006},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-319567},
  pages     = {130-138},
  year      = {2019},
  abstract  = {Objectives Novel formulations (gastro-resistant tablet and intravenous solution) of posaconazole (POS) have been approved in prophylaxis and therapy of invasive fungal diseases (IFDs). Study aim was to analyze treatment strategies and clinical effectiveness. Methods We set up a web-based registry on www.ClinicalSurveys.net for documentation of comprehensive data of patients who received novel POS formulations. Data analysis was split into two groups of patients who received novel POS formulations for antifungal prophylaxis (posaconazole prophylaxis group) and antifungal therapy (posaconazole therapy group), respectively. Results Overall, 180 patients (151 in the posaconazole prophylaxis group and 29 in the posaconazole therapy group) from six German tertiary care centers and hospitalized between 05/2014 - 03/2016 were observed. Median age was 58 years (range: 19 - 77 years) and the most common risk factor for IFD was chemotherapy (n = 136; 76\%). In the posaconazole prophylaxis group and posaconazole therapy group, median POS serum levels at steady-state were 1,068 μg/L (IQR 573-1,498 μg/L) and 904 μg/L (IQR 728-1,550 μg/L), respectively (P = 0.776). During antifungal prophylaxis with POS, nine (6\%) probable/proven fungal breakthroughs were reported and overall survival rate of hospitalization was 86\%. The median overall duration of POS therapy was 18 days (IQR: 7 - 23 days). Fourteen patients (48\%) had progressive IFD under POS therapy, of these five patients (36\%) died related to or likely related to IFD. Conclusions Our study demonstrates clinical effectiveness of antifungal prophylaxis with novel POS formulations. In patients treated for possible/probable/proven IFD, we observed considerable mortality in patients receiving salvage treatment and with infections due to rare fungal species.},
  language  = {en}
}
@article{SpinnerWilleSchwerdtfegeretal.2015,
  author    = {Spinner, Christoph D and Wille, Florian and Schwerdtfeger, Christiane and Thies, Philipp and Tanase, Ursula and Von Figura, Guido and Schmid, Roland M and Heinz, Werner J and Klinker, Hartwig Hf},
  title     = {Pharmacokinetics of chewed vs. swallowed raltegravir in a patient with AIDS and MAI infection: some new conflicting data},
  series = {AIDS Research and Therapy},
  volume    = {12},
  journal   = {AIDS Research and Therapy},
  number    = {1},
  doi       = {10.1186/s12981-014-0041-8},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-144058},
  year      = {2015},
  abstract  = {Background: While HIV, AIDS and atypical Mycobacterium infections are closely linked, the use of Integrase-Inhibitor based cART, notably raltegravir-based regimens is more widespread. RAL should be double-dosed to 800 mg semi-daily in situation of rifampicin co-medication, because RAL is more rapidly metabolized due to rifampicin-induced Uridine-5'-diphosph-gluronosyl-transferase (UGT1A1). Recently, it was speculated that chewed RAL might lead to increased absorption, which might compensate the inductive effect of rifampicin-rapid metabolized RAL, as part of cost-saving effects in countries with high-tuberculosis prevalence and less economic power. Methods: We report measurement of raltegravir pharmacokinetics in a 34-year AIDS-patient suffering from disseminated Mycobacterium avium infection with necessity of parenteral rifampicin treatment. RAL levels were measured with HPLC (internal standard: carbamazepine, LLQ 11 ng/ml, validation with Valistat 2.0 program (Arvecon, Germany)). For statistical analysis, a two-sided Wilcoxon signed rank test for paired samples was used. Results: High intra-personal variability in raltegravir serum levels was seen. Comparable C\(_{max}\) concentrations were found for 800 mg chewed and swallowed RAL, as well as for 400 mg chewed and swallowed RAL. While C\(_{max}\) seems to be more dependent from overall RAL dosing than from swallowed or chewed tablets, increased AUC(12) is clearly linked to higher RAL dosages per administration. Anyway, chewed raltegravir showed a rapid decrease in serum levels. Conclusions: We found no evidence that chewed 400 mg semi-daily raltegravir in rifampicin co-medication leads to optimized pharmacokinetics. There is need for more data from randomized trials for further recommendations.},
  language  = {en}
}
@article{WernerSchmidMueggeetal.2015,
  author    = {Werner, R.A. and Schmid, J.S. and Muegge, D.O. and L{\"u}ckerath, K. and Higuchi, T. and H{\"a}nscheid, H. and Grelle, I. and Reiners, C. and Herrmann, K. and Buck, A.K. and Lapa, C.},
  title     = {Prognostic value of serum tumor markers in medullary thyroid cancer patients undergoing vandetanib treatment},
  series = {Medicine},
  volume    = {94},
  journal   = {Medicine},
  number    = {45},
  doi       = {10.1097/MD.0000000000002016},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-145154},
  pages     = {e2016},
  year      = {2015},
  abstract  = {Tyrosine kinase inhibitors (TKIs) such as vandetanib have shown clinical effectiveness in advanced medullary thyroid cancer (MTC). During TKI treatment, fluctuations in the tumor markers carcinoembryonic antigen (CEA) and calcitonin (CTN) are frequently observed. Their role for treatment monitoring and the decision-making process has not been fully elucidated yet. Twenty-one patients (male, 16, female, 5; mean age, 49±13 years) with progressive MTC receiving vandetanib (300mg orally per day) were considered. Tumor restaging was performed every 3 months including contrast-enhanced computed tomography (CT). Response was assessed according to recent criteria (Response Evaluation Criteria in Solid Tumors, RECIST 1.1). Additionally, CEA and CTN were measured at the day of CT imaging and alterations observed in tumor markers were compared to respective imaging findings (partial response, PR; stable disease, SD; progressive disease, PD). During long-term follow-up (510±350 days [range, 97-1140 days]), CTN and CEA levels initially dropped in 71.4\% and 61.9\% of the patients followed by fluctuations in serum marker levels. A rise in CTN ≥39.5\% between 2 subsequent measurements (defined by ROC analysis) had a sensitivity of 70.6\% and a specificity of 83.2\% in predicting PD with an accuracy of 82.0\% (area under the curve (AUC), 0.76). Oscillations in CEA levels were not predictive for PD. Whereas tumor marker fluctuations in MTC patients undergoing TKI treatment are a frequent phenomenon, a significant rise in CTN ≥40\% turns out to as an early indicator of tumor progression.},
  language  = {en}
}