Efficacy and Safety of Caspofungin for Treatment of Invasive Aspergillosis in Patients Refractory to or Intolerant of Conventional Antifungal Therapy

Maertens, J; Raad, Issam; Petrikkos, George; Boogaerts, Marc; Selleslag, Dominik; Petersen, Finn; Sable, Carole A.; Kartsonis, Nicholas A.; Ngai, Angela; Taylor, Amanda; Patterson, Thomas F.; Denning, David W.; Walsh, Thomas J.

doi:10.1086/423381

Cited by 613 publications

(422 citation statements)

References 39 publications

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“…The response rate to standard-or high-dose L-AmB, haematologica | 2010; 95(4) © F e r r a t a S t o r t i F o u n d a t i o n caspofungin or voriconazole was already reported to range from 32% to 53%. [24][25][26][27][28][29][30] The percentage of success reported in those studies is lower than that observed in our registry, which ranged from 64% to 82%. This could be explained by the very restrictive criteria for response evaluation in pivotal trials.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Ncontrasting

confidence: 61%

Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study

Pagano¹,

Caira²,

Candoni³

et al. 2009

Haematologica

303

217

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Section: © F E R R a T A S T O R T I F O U N D A T I O Ncontrasting

confidence: 61%

Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study

Pagano¹,

Caira²,

Candoni³

et al. 2009

Haematologica

303

217

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“…Finalmente, respecto a los hongos fi lamentosos, específi camente en el caso de Aspergillus, micafungina y caspofungina sólo tienen estudios en escenarios de rescate (falla de un antimicótico previo) [40][41][42] o en intolerancia 43 .…”

Section: Ensayos Clínicos De Efectividadunclassified

“…De las reacciones medicamentosas observadas en pacientes con caspofungina, así como para las otras equinocandinas, se encuentra descrito usualmente fi ebre (7-17%), exantema (13,8%), escalofríos (5,3%), fl ebitis (3,5%), náuseas (1,8%), y otras anormalidades de laboratorio 27,33 . Para caspofungina se han descrito dos eventos adversos serios como anafi laxia 44 e infi ltrados pulmonares (40), los que se observaron en 11 de 979 pacientes (1,1%).…”

Section: Efectos Adversosunclassified

Equinocandinas

2011

Rev. chil. infectol.

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EchinocandinsThe echinocandins, caspofugin, micafungin, and anidulafungin, are lipopeptides that inhibit fungal growth by binding to β -(1.3) d glucan synthase. This enzyme is responsible for the formation of the peptidoglycan cell wall, and it is essential in fungi such as Candida spp, but less important in the case of Aspergillus and Fusarium species. We review the history, pharmacology and clinical trials that have showed clinical effi cacy similar to amphotericin B for the management of fungal infections such as candidemia, invasive candidiasis and aspergillosis, even in cases refractory to initial treatment. These drugs have less toxicity and discontinuation is uncommonly required. Despite similar spectrum and tolerability, there are several pharmacological differences. Only a few clinical trials compare the clinical effi cacy between them and their clinical application cannot be generalized. However, the echinocandins have demonstrated clinical effi cacy in patients with invasive candidiasis and in others forms of systemic mycoses.

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“…Responses in published reports are of the order of 45% (95% CI 40.2% to 50.3%) (Figure 3). [45][46][47][48] Combination therapy Poor response rates for primary and salvage monotherapy therapy for IFI and the availability of agents with differing mechanisms of action have fueled recent reviews. [49][50][51][52] Arguments for considering combination therapy include enhanced fungal killing (synergy), an enhanced spectrum of activity, prevention of development of resistance, and reduction of drug-related toxicities.…”

Section: Salvage Monotherapymentioning

confidence: 99%

Of Yeasts and Hyphae: A Hematologist’s Approach to Antifungal Therapy

Bow¹

2006

Hematology

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Improvements in anticancer treatments, the ability to modify myelosuppression profiles, greater duration and intensity of immunosuppression, and the variety of available antimicrobial therapies have influenced the spectrum of pathogens associated with invasive fungal infection complicating treatment of hematological malignancies and hematopoietic stem cell transplantation. The approaches to the management of these infections encompass strategies of prevention for all those at risk, pre-emptive therapy based upon surrogates of infection before the onset of clinical disease, empirical therapy for patients with clinical evidence of early disease, and directed or targeted therapy for infected patients with established disease. Chemoprophylaxis is effective if applied to the highest risk patients over the duration of the risk. Pre-emptive strategies, while promising, have yet to be validated and linked to reliably predictive nonmicrobiological diagnostic techniques. Empirical antifungal therapy, as it is currently applied, now seems questionable. Patients with probable or proven invasive fungal infection still have suboptimal outcomes despite the availability of promising anti-fungal agents. Strategies examining the concept of dose-intensity and combination regimens require careful study and cannot yet be regarded as an acceptable standard of practice. Changing Epidemiology of Invasive Fungal Infection in Hematological Malignancies and Stem Cell TransplantsInterest in the field of medical mycology has expanded considerably as the numbers of immuno-and myelo-suppressed patients susceptible to opportunistic invasive fungal infections (IFI) increase. While the majority (95-97%) of invasive yeast infections are due to five species, predominantly Candida albicans, followed by C. tropicalis, C. glabrata, C. parapsilosis, and C. krusei, emerging importance of infections due to non-albicans Candida spp. including C. glabrata, C. parapsilosis, and C. krusei in high-risk cancer patients is noteworthy. 1 The remaining 3% to 5% of pathogens include other non-albicans Candida spp.. and non-Candida yeasts such as Trichosporon spp., Cryptococcus spp., Blastoschizomyces spp., and Malassezia spp.. 2,3 The risks for IFI among hematopoietic stem cell transplants (HSCT) increases as the disparity of the donor:recipient pair (autologous HSCT, 0.6%; matched related donor HSCT, 3.7%; mismatched related or unrelated donor HSCT, 5.9%, P < 0.0001). 4 The changing character of the HSCT populations together with effective antiCandida agents contribute to a changing spectrum of opportunistic mycoses. In a comparison of transplant patients with IFI to a more general population of patients at risk, the proportion of Candida infections decreased by approximately 45% (77% to 42%); however, that due to Aspergillus spp. has more than doubled (13% to 29%) and that due to other environmental moulds including Fusarium spp., Scedosporium spp., the zygomycetes, and the less com-

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Efficacy and Safety of Caspofungin for Treatment of Invasive Aspergillosis in Patients Refractory to or Intolerant of Conventional Antifungal Therapy

Abstract: Caspofungin demonstrated usefulness in the salvage treatment of IA.

Cited by 613 publications

References 39 publications

Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study

Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study

Equinocandinas

Of Yeasts and Hyphae: A Hematologist’s Approach to Antifungal Therapy

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