Efficacy of Caspofungin in the Treatment of Esophageal Candidiasis Resistant to Fluconazole

Kartsonis, Nicholas A.; DiNubile, Mark J.; Bartizal, Ken; Hicks, Patricia Scott; Ryan, Desmon̄d; Sable, Carole A.

doi:10.1097/00126334-200210010-00009

Cited by 69 publications

(33 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Adult patients in the first comparative group with mucosal candidiasis (esophageal and/or oropharyngeal candidiasis) received a 50-mg or 70-mg daily dose of caspofungin during one of three phase II studies (protocols 003, 004, and 007) (3,12,27). Adult patients in the second comparative group with persistent fever and neutropenia received a 50-mg daily dose (following a loading dose of 70 mg on day 1) during the phase III study of caspofungin for empirical antifungal therapy (protocol 026) (31).…”

Section: Methodsmentioning

confidence: 99%

“…Patients with mucosal candidiasis (from protocols 004 and 007) served as the primary comparators, because the full pharmacokinetic sampling was available in these two clinical trials (3,12). Profile sampling permitted comparisons of pharmacokinetic parameters, including end-of-infusion concentrations (C 1 ), trough concentrations (C 24 ), and area under the concentration-time curve (AUC) values.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Pharmacokinetics, Safety, and Tolerability of Caspofungin in Children and Adolescents

Walsh

Adamson

Seibel

et al. 2005

Antimicrob Agents Chemother

Self Cite

223

149

View full text Add to dashboard Cite

Caspofungin is a parenteral antifungal that inhibits beta-1,3-D-glucan synthesis. Although licensed for adult use, the appropriate caspofungin dosing regimen in pediatric patients is not yet known. We therefore investigated the pharmacokinetics and safety of caspofungin in pediatric patients. Thirty-nine children (ages 2 to 11 years) and adolescents (ages 12 to 17 years) with neutropenia were administered caspofungin using either a weight-based regimen (1 mg/kg of body weight/day) or a body surface area regimen (50 mg/m 2 /day or 70 mg/m 2 /day). Plasma samples for caspofungin profiles were collected on days 1 and 4. These results were compared to those from adults treated with either 50 or 70 mg/day for mucosal candidiasis. In children receiving 1 mg/kg/day (maximum, 50 mg/day), the area under the concentration-time curve over 24 h (AUC 0-24 ) was significantly smaller (46% after multiple doses) than that observed in adults receiving 50 mg/day (P < 0.001). In children and adolescents receiving 50 mg/m 2 /day (maximum, 70 mg/day), the AUC 0-24 following multiple doses was similar to that for the exposure in adults receiving 50 mg/day. The AUC 0-24 and concentration trough (at 24 h) in pediatric patients receiving the 50-mg/m 2 daily regimen were consistent across the range of ages. Caspofungin was generally well tolerated in this study. None of the patients developed a serious drug-related adverse event or were discontinued for toxicity. These results demonstrate that caspofungin at 1 mg/kg/day in pediatric patients is suboptimal. Caspofungin administration at 50 mg/m 2 /day provides a comparable exposure to that of adult patients treated with 50 mg/day.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Pharmacokinetics, Safety, and Tolerability of Caspofungin in Children and Adolescents

Walsh

Adamson

Seibel

et al. 2005

Antimicrob Agents Chemother

Self Cite

223

149

View full text Add to dashboard Cite

show abstract

“…Four weeks after discontinuation of the study drug, symptoms had recurred in 18 (28%) of 64 patients who had been treated with caspofungin and in 12 (17%) of 72 patients who had been given fluconazole [116] . Caspofungin appears to be a suitable antifungal agent in patients with esophageal candidiasis clinically refractory to fluconazole [117] .…”

Section: Clinical Efficacy Empirical Therapy For Presumed Fungal Infementioning

confidence: 99%

The Echinocandins: Comparison of Their Pharmacokinetics, Pharmacodynamics and Clinical Applications

Wagner

Graninger²,

Presterl³

et al. 2006

Pharmacology

116

View full text Add to dashboard Cite

Caspofungin, micafungin and anidulafungin are three drugs of the echinocandin class of antifungals available for intravenous treatment of invasive candidiasis and aspergillosis. They exhibit high in vitro and in vivo activities against Candida spp. and Aspergillus spp. In various clinical studies investigating candidemia and invasive candidiasis, Candida esophagitis, and fever in neutropenia, the clinical efficacy of the echinocandin tested was similar to that of established antifungals. Antifungal activity against strains no longer susceptible to conventional antifungal agents, such as fluconazole and amphotericin B suggests that echinocandins can be used as salvage therapy in life-threatening fungal infections. There is no cross-resistance to other antifungals. Excellent safety and tolerability of treatment with caspofungin has been documented over a total of 4.3 million patient days. Echinocandins are poor substrates of the cytochrome P450 enzyme family and can be safely co-administered with most drugs without the need for dosage adaptation. No dose reduction is required in renal impairment. A reduction in the daily maintenance dose has been recommended for caspofungin, but not for micafungin and anidulafungin in patients presenting with mild to moderate hepatic failure.

show abstract

“…Essenziell ist dabei eine Suppressionstherapie. In diesen Situationen zeigen neuere Studien mit neuen Triazolen (Voriconazol und Posaconazol) sowie Echinocandinen (Caspofungin) eine gute Aktivität gegen viele Candidaspezies [6,8,11,14,19,48].Generell ist bei nicht veränderter Immunlage die Rückfallrate sehr hoch (>50%) und eine Sekundärprophylaxe angezeigt.…”

Section: Gastrointestinale Manifestationenunclassified

Therapie schwerer Pilzinfektionen

Battegay¹,

Flückiger²

2003

Der Internist

View full text Add to dashboard Cite

Severe fungal infections increase in numbers in the Western world. This is due to more intensive therapies against cancers leading to severe and prolonged immunosuppression. For many years treatment of severe fungal infections had to be done solely with amphothericin B desoxycholate and 5-fluorocytosine. With the advent of triazoles such as fluconazole, lipid formulations of amphotericin B and the development of echinocandines such as caspofungin also severe candidiasis and invasive aspergillosis has become treatable. In particular, caspofungin for invasive candidiasis and voriconazole for invasive aspergillosis seem at least equivalent to amphotericin B. A clear advantage is the advent of lipid formulations of amphotericin B. This regards especially side effects which are reduced with these newer formulations, i.e. nephrotoxicity. Due to the fact that prospective trials are difficult to conduct because patient populations may vary considerably (especially the underlying disease) many comparisons were not yet performed. Nevertheless, promising results indicate that certain combinations of antifungals may enhance prognosis of refractory fungal infections with a so far very serious prognosis.

show abstract

Efficacy of Caspofungin in the Treatment of Esophageal Candidiasis Resistant to Fluconazole

Cited by 69 publications

References 32 publications

Pharmacokinetics, Safety, and Tolerability of Caspofungin in Children and Adolescents

Pharmacokinetics, Safety, and Tolerability of Caspofungin in Children and Adolescents

The Echinocandins: Comparison of Their Pharmacokinetics, Pharmacodynamics and Clinical Applications

Therapie schwerer Pilzinfektionen

Contact Info

Product

Resources

About