Browsing by Author "Jiang, J"

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    Multicenter Registry of Patients Receiving Systemic Mold-Active Triazoles for the Management of Invasive Fungal Infections.
    (Infectious diseases and therapy, 2022-08) Ostrosky-Zeichner, L; Nguyen, MH; Bubalo, J; Alexander, BD; Miceli, MH; Pappas, PG; Jiang, J; Song, Y; Thompson, GR

    Introduction

    'Real-world' data for mold-active triazoles (MATs) in the treatment of invasive fungal infections (IFIs) are lacking. This study evaluated usage of MATs in a disease registry for the management of IFIs.

    Methods

    Data were collected for this multicenter, observational, prospective study from 55 US centers, between March 2017 and April 2020. Eligible patients received isavuconazole, posaconazole, or voriconazole as MAT monotherapy (one MAT) or multiple/sequenced MAT therapy (more than one MAT) for prophylaxis or treatment. Patients were enrolled within 60 days of MAT initiation. The primary objective was to characterize patients receiving a MAT and their patterns of therapy. The full analysis set (FAS) included eligible patients for the relevant enrollment protocol, and the safety analysis set (SAF) included patients who received ≥ 1 MAT dose.

    Results

    Overall, 2009 patients were enrolled in the SAF. The FAS comprised 1993 patients (510 isavuconazole; 540 posaconazole; 491 voriconazole; 452 multiple/sequenced MAT therapies); 816 and 1177 received treatment and prophylaxis at study index/enrollment, respectively. Around half (57.8%) of patients were male, and median age was 59 years. Among patients with IFIs during the study, the most common pathogens were Aspergillus fumigatus in the isavuconazole (18.2% [10/55]) and voriconazole (25.5% [12/47]) groups and Candida glabrata in the posaconazole group (20.9% [9/43]); the lungs were the most common infection site (58.2% [166/285]). Most patients were maintained on MAT monotherapy (77.3% [1541/1993]), and 79.4% (1520/1915) completed their MAT therapies. A complete/partial clinical response was reported in 59.1% (591/1001) of patients with a clinical response assessment. Breakthrough IFIs were reported in 7.1% (73/1030) of prophylaxis patients. Adverse drug reactions (ADRs) were reported in 14.7% (296/2009) of patients (3.9% [20/514] isavuconazole; 11.3% [62/547] posaconazole; 14.2% [70/494] voriconazole).

    Conclusions

    In this 'real-world' study, most patients remained on their initial therapy and completed their MAT therapy. Over half of patients receiving MATs for IFIs had a successful response, and most receiving prophylaxis did not develop breakthrough IFIs. ADRs were uncommon.
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    Unforced surface air temperature variability and its contrasting relationship with the anomalous TOA energy flux at local and global spatial scales
    (Journal of Climate, 2016-01-01) Brown, PT; Li, W; Jiang, J; Su, H
    Unforced global mean surface air temperature (T) is stable in the long term primarily because warm T anomalies are associated with enhanced outgoing longwave radiation (↑LW) to space and thus a negative net radiative energy flux (N, positive downward) at the top of the atmosphere (TOA). However, it is shown here that, with the exception of high latitudinal and specific continental regions, warm unforced surface air temperature anomalies at the local spatial scale [T(θ, φ), where (θ, φ) = (latitude, longitude)] tend to be associated with anomalously positive N(θ, φ). It is revealed that this occurs mainly because warm T(θ, φ) anomalies are accompanied by anomalously low surface albedo near sea ice margins and over high altitudes, low cloud albedo over much of the middle and low latitudes, and a large water vapor greenhouse effect over the deep Indo-Pacific. It is shown here that the negative N versus T relationship arises because warm anomalies are associated with large divergence of atmospheric energy transport over the tropical Pacific [where the N(θ, φ) versus T(θ, φ) relationship tends to be positive] and convergence of atmospheric energy transport at high latitudes [where the N(θ, φ) versus T(θ, φ) relationship tends to be negative]. Additionally, the characteristic surface temperature pattern contains anomalously cool regions where a positive local N(θ, φ) versus T(θ, φ) relationship helps induce negative N. Finally, large-scale atmospheric circulation changes play a critical role in the production of the negative N versus T relationship as they drive cloud reduction and atmospheric drying over large portions of the tropics and subtropics, which allows for greatly enhanced ↑LW.