A randomized double-blind study of caspofungin versus fluconazole for the treatment of esophageal candidiasis

Villanueva, Álvaro; Gotuzzo, Eduardo; Arathoon, Eduardo; Noriega, Lorena; Kartsonis, Nicholas A.; Lupinacci, Robert; Smietana, Juanita M; DiNubile, Mark J.; Sable, Carole A.

doi:10.1016/s0002-9343(02)01191-9

Cited by 261 publications

(166 citation statements)

References 23 publications

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“…CAS has proven to be effective and well tolerated in the treatment of infections caused by Aspergillus spp, Candida albicans and non-C. albicans spp. [10][11][12][13][14] CAS (70 mg loading dose followed by 50 mg daily) was used in an open-label, noncomparative, multicenter salvage trial of patients (n ¼ 90) with invasive aspergillosis. 14,15 These patients had been unresponsive to 7 days of prior standard therapy or had been unable to tolerate therapy.…”

Section: Invasive Fungal Infectionmentioning

confidence: 99%

Caspofungin as second-line therapy for fever of unknown origin or invasive fungal infection following allogeneic stem cell transplantation

Trenschel

Ditschkowski

Elmaagacli

et al. 2005

Bone Marrow Transplant

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Section: Invasive Fungal Infectionmentioning

confidence: 99%

Caspofungin as second-line therapy for fever of unknown origin or invasive fungal infection following allogeneic stem cell transplantation

Trenschel

Ditschkowski

Elmaagacli

et al. 2005

Bone Marrow Transplant

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“…In six studies using 7,109 clinical isolates of various species of Candida, caspofungin inhibited the overwhelming majority of isolates at concentrations Յ2 mcg/mL (19,20,27,28,36,37). This held true even for fluconazole-resistant isolates.…”

Section: Caspofungin Vs Candidamentioning

confidence: 99%

“…Villanueva et al compared caspofungin to fluconazole for the treatment of esophageal candidiasis in a double-blind, randomized study (36). One hundred seventy-seven adult patients with endoscopically-and microbiologically-confirmed candidal esophagitis were randomized to receive caspofungin 50 mg IV daily or fluconazole 200 mg IV daily.…”

Section: Clinical Trials Caspofungin In Candida Infectionsmentioning

confidence: 99%

Expansion of a recent class of broad-spectrum antifungal agents: the echinocandins

Manfredi¹

2009

Microbiol Med

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Espansione di una recente classe di agenti antimicotici ad ampio spettro: le echinocandine SUMMARY The echinocandins show comparable efficacy in the treatment of candidemia and invasive candidiasis. Caspofungin and micafungin appear to be similarly efficacious in salvage therapy in aspergillosis; anidulafungin has excellent in vitro activity against Aspergillus species but as yet there are no sufficient clinical data for anidulafungin in this disease state. Each drug has minor advantages and disadvantages compared to the others of the same classe; however, there are large differences in the approved indications for the different drugs. The formulary selection process should consider the direct and indirect costs of the single agents; the characteristics of the patient population at risk for invasive mycosis, such as frequent use of interacting drugs and the burden of monitoring plasma drug levels of drugs; and the implications of using products for indications which have not been still approved (off-label indications).

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“…• Gastrointestinal toxicity is infrequently seen with caspofungin: nausea 2-6%; vomiting 2-3.5%; diarrhoea 1-4% 84,107,108,133 Hepatotoxicity • Hepatotoxicity (elevated transaminases) occur in 1-15% of patients 84,88,107 • Early data showed an increase in the plasma concentrations of caspofungin and increased transaminases when caspofungin was concomitantly administered with cyclosporin; the Product Information states that the combination may be used when the potential benefits outweigh the potential risk 34 • However, a number of observational studies in children and adult subjects have demonstrated the safety of this combination 62,134,135 Other • Nephrotoxicity occurs in 0-8% of patients (significantly less than AmB-D) 84,88,107 • IRAEs occur less frequently than they do with the amphotericin B preparations: chills 0-14% 84,88,107 • Rash is infrequently observed with caspofungin: 1-6% 84,133 5-FC Gastrointestinal toxicity…”

Section: Nephrotoxicitymentioning

confidence: 99%

Optimizing antifungal drug dosing and monitoring to avoid toxicity and improve outcomes in patients with haematological disorders

Worth

Blyth

Booth

et al. 2008

Internal Medicine Journal

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Antifungal prophylaxis, empirical therapy and treatment of established fungal infections in the haematology population may be associated with significant toxicity or drug interactions leading to sub-therapeutic antifungal drug concentrations and poorer clinical outcomes. These risks may be minimised by clinical assessment, laboratory monitoring of biochemical or haematological indices, avoidance of particular drug combinations and dose modification in certain circumstances. Specific measures, such as the optimal timing of oral drug administration in relation to meals, use of pre-hydration and electrolyte supplementation may also be required. For certain agents, therapeutic drug monitoring (TDM) is warranted where non-compliance, non-linear pharmacokinetics, a narrow therapeutic window, suspected drug interaction or unexpected toxicity are encountered. Pharmacokinetics and pharmacodynamics of clinical relevance to the haematology population are discussed for the azole, polyene and echinocandin classes of antifungal agents. The evidence supporting an association between TDM and enhanced treatment outcomes is presented for individual antifungal drugs, and recommendations for clinical practice are provided. Further randomised study of newer antifungal agents, such as posaconazole, is required to explore the potential for improved clinical outcomes in association with TDM.Understanding a drug's pharmacokinetics and its pharmacodynamic effects affords the clinician the capacity to optimize drug exposure while minimizing or avoiding drug interactions and toxicities. Therapeutic drug monitoring (TDM) may also be employed during the treatment period to ensure that the selected drug dosage falls within the therapeutic window for an individual patient.These clinical caveats are particularly relevant to the haematology population where the frequent requirement for polypharmacy and the complexity of comorbidities can significantly influence the success of antifungal therapy. This section of the guidelines describes the potential drugdrug interactions and toxicities related to antifungal use and how they may be avoided. It also considers the latest

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A randomized double-blind study of caspofungin versus fluconazole for the treatment of esophageal candidiasis

Cited by 261 publications

References 23 publications

Caspofungin as second-line therapy for fever of unknown origin or invasive fungal infection following allogeneic stem cell transplantation

Caspofungin as second-line therapy for fever of unknown origin or invasive fungal infection following allogeneic stem cell transplantation

Expansion of a recent class of broad-spectrum antifungal agents: the echinocandins

Optimizing antifungal drug dosing and monitoring to avoid toxicity and improve outcomes in patients with haematological disorders

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