Caspofungin versus Liposomal Amphotericin B for Empirical Antifungal Therapy in Patients with Persistent Fever and Neutropenia

Walsh, Thomas J.; Teppler, Hedy; Donowitz, Gerald R.; Maertens, Johan; Baden, Lindsey R.; Dmoszyńska, Anna; Cornely, Oliver A.; Bourque, Michael; Lupinacci, Robert; Sable, Carole A.; DePauw, Ben

doi:10.1056/nejmoa040446

Cited by 838 publications

(705 citation statements)

References 22 publications

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“…This is supported by various efficacy trials in HSCT recipients and in other patient populations treated for invasive aspergillosis, febrile neutropenia, Candida or other invasive fungal infections. 2,[26][27][28][29][30][31][32] In our study, the proportion of patients with pDDIs ranged from 64 to 84%, depending on the antimycotic drug used. By screening the entire medication list for pDDIs and by including not only pDDIs of major severity, an even higher prevalence might have been reached.…”

Section: Discussionmentioning

confidence: 99%

Drug interactions and adverse events associated with antimycotic drugs used for invasive aspergillosis in hematopoietic SCT

Egger

Meier

Leu

et al. 2009

Bone Marrow Transplant

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The aim of this study was to assess the frequency of potential drug-drug interactions (pDDIs) and adverse drug events (ADEs) associated with antimycotics in hospitalized patients with hematopoietic SCT (HSCT). Of the 120 HSCT recipients evaluated, 36 received antimycotics. A total of 124 ADEs were recorded in 32 of the 36 patients treated, with 54 ADEs being possibly and 9 probably related to antimycotics. Of the treatments with amphotericin B, 93% were associated with one or more possible and 36% with probable ADEs. The corresponding figures for lipid-based amphotericin B were 100% and 7%, for voriconazole 68% and 11% and for caspofungin 70% and 0%. A total of 57 potentially severe DDIs associated with antimycotics were detected in 31 of the 36 patients. Of these, 14 DDIs were a possible cause of an ADE and 5 (4 times a combination of voriconazole with CYA and once a combination of CYA with conventional amphotericin B) were probably related. Although the prevalence of pDDIs and ADEs is high in HSCT patients, ADEs related with a high probability to treatment with antimycotics are rare. Regarding the high prevalence of pDDIs, our findings underscore the importance of close monitoring of laboratory and clinical parameters, as well as dose adjustment for critical drugs, in patients with HSCT.

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Section: Discussionmentioning

confidence: 99%

Drug interactions and adverse events associated with antimycotic drugs used for invasive aspergillosis in hematopoietic SCT

Egger

Meier

Leu

et al. 2009

Bone Marrow Transplant

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“…In patients experiencing prolonged FUO (>48 h), pulmonary high-resolution or spiral CT should be performed [4,23]. Early treatment with caspofungin (70 mg loading dose followed by 50 mg QD) or liposomal amphotericin B (3 mg/kg QD) may be clinically warranted in high-risk patients [59]. In the event of probable (measured by two positive serum galactomannan samples or halo signs in pulmonary CT scan per modified EORTC/MSG criteria) or proven invasive aspergillosis, the treatment of choice is voriconazole 6 mg/kg loading dose followed by 4 mg/kg BID, as recommended by IDSA [22].…”

Section: Treatment Of Infectionsmentioning

confidence: 99%

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

et al. 2008

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International audienceInfection is a significant cause of morbidity and death in patients with chronic lymphocytic leukemia (CLL). Increased infectious events may arise from the multiple courses of immunosuppressive therapy and progressive deterioration of a patient's immune system over the course of disease. The humanized, anti-CD52 monoclonal antibody alemtuzumab (Campath or Campath-1H) has shown notable activity for both untreated and fludarabine-refractory CLL. The antibody not only targets malignant cells but also affects normal, healthy immune cells. The cumulative effects of the malignancy and successive courses of treatments adversely impinge on a patient's defense response to certain bacterial, fungal, and viral infections. In this review article, we provide an overview of common infectious events associated with alemtuzumab therapy in CLL. We also discuss recommendations for effectively monitoring and managing infections in CLL patients

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“…Prime examples for this approach in the field of antifungal pharmacology include the successful clinical development of caspofungin [26][27][28] and micafungin [29][30][31] through an ordered set of systematic investigations in Phase I-III clinical trials for definition of pediatric doses, collection of limited safety and efficacy data in the target indications that support the feasibility of extrapolation of safety and efficacy from large randomized adult clinical trials [31,32], supplemented by population PK studies [33], PK/PD analyses and establishment of a postmarketing surveillance system. Pharmacologically more complex drugs such as voriconazole, however, may require more focused efforts in pediatric populations with an unmet medical need [34][35][36], as do premature neonates, in whom PK and PD often need separate study.…”

Section: Antifungal Therapy For Pediatric Fungal Infectionsmentioning

confidence: 99%

Invasive fungal infections in the pediatric population

Lehrnbecher

Groll

2011

Expert Review of Anti-infective Therapy

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Caspofungin versus Liposomal Amphotericin B for Empirical Antifungal Therapy in Patients with Persistent Fever and Neutropenia

Abstract: Caspofungin is as effective as and generally better tolerated than liposomal amphotericin B when given as empirical antifungal therapy in patients with persistent fever and neutropenia.

Cited by 838 publications

References 22 publications

Drug interactions and adverse events associated with antimycotic drugs used for invasive aspergillosis in hematopoietic SCT

Drug interactions and adverse events associated with antimycotic drugs used for invasive aspergillosis in hematopoietic SCT

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

Invasive fungal infections in the pediatric population

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