Intensive Pharmaceutical versus Routine Care on Antifungal Drug Therapy Safety in Adult Hematology–Oncology Patients: A Prospective Multicenter Pre–Post Study (MAAMy)

Invasive fungal diseases (IFDs) are associated with high mortality in hematology–oncology patients. Nevertheless, inappropriate antifungal use remains common. Thus, this study investigated the impact of intensive pharmaceutical care independent of antifungal stewardship programs on drug therapy safety and patient-relevant outcomes in hematology–oncology patients receiving systemic antifungal drugs. A prospective pre–post study was conducted in adult patients receiving systemic antifungal drugs on hematology–oncology general wards at three German tertiary teaching hospitals, consisting of a 12-month observation phase within routine care (OPh) and a 12-month consultation phase with intensive pharmaceutical care (CPh). The CPh included ward pharmacists reviewing antifungal prescriptions and distributing pocket cards summarizing appropriate antifungal prescribing. Primary endpoints were unresolved systemic antifungal drug-related problems (DRP AF , i.e. medication errors and side effects) and the Medication Appropriateness Index of systemic antifungal drugs (MAI AF ) per patient case. Secondary endpoints included IFD-related deaths on study wards, intensive care unit (ICU) admissions, and postponed anticancer therapies. A total of 158 and 151 patients were included in the OPh and CPh, respectively, resulting in 273 and 270 patient cases due to multiple hospital admissions. Unresolved DRP AF and MAI AF per patient case were lower in the CPh compared with the OPh [median (IQR), adjusted regression coefficient B (95% CI): 0 (0–1) versus 1 (0–2), −0.923 (−1.160 to −0.686), P < 0.001; 0 (0–0) versus 2 (0–2), −1.125 (−1.398 to −0.853), P < 0.001]. 180 (47.5%) antifungal prescriptions were rated as inappropriate in the OPh versus 66 (16.6%) in the CPh ( P < 0.001). The odds ratio for the composite endpoint of IFD-related death, ICU admission, or postponed anticancer therapy was 0.407 (95% CI 0.140–1.181, P = 0.098), with numerically lower odds of these events in the CPh. Intensive pharmaceutical care substantially improved antifungal drug therapy safety and suggested a beneficial impact on patient-relevant outcomes, supporting its implementation in clinical practice. DRKS.de, DRKS00022878.