Caspofungin Use in Daily Clinical Practice for Treatment of Invasive Aspergillosis: Results of a Prospective Observational Registry

Abstract

BackgroundA prospective observational registry assessed real world experience with caspofungin monotherapy or combination therapy for the initial or salvage treatment of proven or probable invasive aspergillosis (IA).MethodsData were collected from April 2006 to September 2007 for patients treated with caspofungin for a single episode of IA. Clinical effectiveness was categorized as favorable (complete or partial) or unfavorable (stable disease or failure) at the end of caspofungin therapy (EOCT).ResultsConsecutive patients (n = 103) with proven or probable IA (per EORTC/MSG criteria) were identified from 11 countries. Malignancy (76.7%), neutropenia (64.1%), allogeneic hematopoietic stem cell transplantation (HSCT, 22.3%), solid organ transplantation (8.7%), autologous HSCT (4.9%), and HIV/AIDS (2.9%) were the most common underlying conditions. Most patients (84.5%) had pulmonary IA. Aspergillus fumigatus was the most frequently isolated species. The majority of patients received caspofungin monotherapy (82.5%) primarily as salvage therapy (82.4%). The main reason for switching to salvage therapy was clinical failure of the first-line therapy (69%). A favorable response at EOCT was seen in 56.4% (57/101) of patients overall, including 56.5% (48/85) and 56.3% (9/16) of patients receiving caspofungin monotherapy and combination therapy, respectively. Favorable response rates in clinically relevant subgroups were: malignancy, 51.9% (41/79); allogeneic HSCT, 56.5% (13/23); and neutropenia at time of hospitalization, 53.0% (35/66). There was a 72.3% (73/101) survival at 7 days after EOCT. Serious adverse events related to caspofungin were reported in 4 cases (3.9%); 3 patients (2.9%) discontinued treatment due to an adverse event related to caspofungin.ConclusionsCaspofungin was both effective and well tolerated among high-risk patient groups such as those with neutropenia and active malignancies.

Current Role of Echinocandins in the Management of Invasive Aspergillosis

“…A favorable response was observed in 45% (37/83) of patients, including 50% (32/64) of those with pulmonary aspergillosis and 23% (3/13) of those with a disseminated infection [68]. Another two prospective observation studies on salvage monotherapy with caspofungin reported a favorable response in 44% (20/45, mostly refractory to amphotericin B) and 56% (39/70) of patients [64,69]. Additionally, several retrospective studies have been published.…”

“…In none of the two studies, serious drugrelated adverse events or discontinuations due to drugrelated adverse events were observed. In a recently published results from a prospective observational registry, caspofungin was used as first line therapy for IA in 20 patients (in 5 cases as a part of combination therapy), and 60% of patients in both groups (9/15 and 3/5) had a favorable (complete or partial) response [64]. Similarly, in 12 neutropenic patients with IA, 42% (5/12) responded to primary therapy with caspofungin [65].…”

Equinocandinas

“…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 .…”

“…También es común la presencia de anormalidades de laboratorio, las cuales ocurren en diferentes frecuencias (entre 1 y 20%) como: hipopotasemia, hipoalbuminemia, elevación de aminotransferasas y aumento de fosfatasa alcalina son los más comunes 33,42 . Sin embargo, al com- www.sochinf.cl parar la frecuencia de ocurrencia de estos últimos entre caspofungina y anfotericina B, la incidencia fue mucho mayor con esta última (24,3 vs 54%); asimismo la nefrotoxicidad fue de 8,4% contra 24,8% respectivamente, del mismo modo que la hipokalemia 27 .…”

Echinocandin-Resistant Candida: Molecular Methods and Phenotypes

“…There is now an extensive, decade-long clinical experience using the echinocandin drugs anidulafungin, caspofungin, and micafungin to treat mucosal and invasive forms of candidiasis [1][2][3][4] as well as, on a limited basis, invasive aspergillosis [5]. Overall, the drugs demonstrate a high therapeutic index and excellent safety and tolerability profiles [6][7][8].…”