Caspofungin for post solid organ transplant invasive fungal disease: results of a retrospective observational study

Abstract

M. Winkler, J. Pratschke, U. Schulz, S. Zheng, M. Zhang, W. Li, M. Lu, D. Sgarabotto, G. Sganga, P. Kaskel, S. Chandwani, L. Ma, J. Petrovic, M. Shivaprakash. Caspofungin for post solid organ transplant invasive fungal disease: results of a retrospective observational study. Transpl Infect Dis 2010: 12: 230–237. All rights reservedObjectiveThis study was designed to determine clinical outcomes with caspofungin in patients with proven or probable invasive fungal infection (IFI) after a solid organ transplant (SOT) procedure.MethodsIn this retrospective observational study, data were collected for a single episode of IFI in patients with an SOT between January 2004 and June 2007. Response was determined by the investigator as favorable (complete or partial) or unfavorable (stable disease or failure) at the end of caspofungin therapy (EOCT). The primary effectiveness population was the proportion of patients who received ≥5 doses of caspofungin (modified all-patients-treated population). Safety was assessed for patients who received ≥1 dose of caspofungin.ResultsA total 81 of patients from 13 sites in China, Germany, Italy, and the United Kingdom were enrolled, including 49 (60%) liver, 22 (27%) heart, 5 (6%) lung, 2 (2%) kidney, 2 (2%) liver and kidney, and 1 (1%) pancreas and kidney recipients. Candidiasis was diagnosed in 64/81 patients (79%) and aspergillosis in 22/81 patients (27%). Most patients received caspofungin monotherapy (75%). Caspofungin was given as first-line therapy to 59 (73%) patients. The overall favorable response at EOCT was 87% (58/67; 95% confidence interval [CI]: 76%, 94%), with favorable responses in 88% (43/49; 95% CI: 75%, 95%) of patients receiving caspofungin monotherapy and 83% (15/18; 95% CI: 59%, 96%) of patients receiving combination therapy with caspofungin (modified all-patients-treated population). Response by type of SOT was as follows: liver 87% (39/45), heart 93% (14/15), kidney 100% (5/5), and lung 50% (2/4). An overall survival rate (all-patients-treated) of 69% (56/81; 95% CI: 59%, 79%) was observed at 7 days post EOCT. No serious drug-related adverse events were reported.ConclusionIn this study, caspofungin was effective and well tolerated in the treatment of IFIs involving SOT recipients.

Caspofungin versus fluconazole as prophylaxis of invasive fungal infection in high‐risk liver transplantation recipients: A propensity score analysis

“…Other studies performed in patients with liver disease confirm the hepatic safety of caspofungin. (10,16,(31)(32)(33) The present study is subject to a number of limitations. First, it is not a clinical trial, and selection of prophylaxis regimens could be conditioned by various circumstances in a specific case or center.…”

Invasive fungal infections in solid organ transplant recipients

“…In an observational study of 19 SOT recipients, Winkler et al . found a favourable response with caspofungin used as first‐line treatment in 78% of patients receiving monotherapy and in 70% of those receiving combination therapy.…”

Defining breakthrough invasive fungal infection–Position paper of the mycoses study group education and research consortium and the European Confederation of Medical Mycology

“…Studies on targeted antifungal treatment in SOT recipients defined the day of diagnosis of breakthrough IFI as the day when EORTC/MSG criteria were met . Observation periods, when reported, began on days 1 or day 6 of pre‐emptive treatment and ended 1 week and 3 months after treatment.…”