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Voriconazole for invasive bone aspergillosis: a worldwide experience of 20 cases
Houria Mouas1, Irja Lutsar, Bertrand Dupont
1Service des Maladies Infectieuses et Tropicales, Hôpital Necker, Paris, France.
Unlabelled:
BACKGROUND; Bone aspergillosis remains a rare but potentially devastating fungal disease. Although voriconazole is effective for invasive pulmonary aspergillosis, evidence of its efficacy for aspergillosis located in bone is limited.
Methods:
We report our experience with voriconazole in 4 cases of invasive bone aspergillosis. In addition, all cases of probable and definite bone aspergillosis from the Pfizer clinical database were reviewed and analyzed to determine the safety and efficacy of voriconazole treatment. Global response was evaluated at the end of therapy on the basis of a composite assessment of overall clinical, radiological, and mycological responses.
Results:
Twenty patients are described, of whom 18 had definite bone involvement diagnosed (spondylodiskitis in 9, sternum/rib osteomyelitis in 6, and peripheral bone involvement in 5). Of 20 patients, 14 were immunocompromised. Oral or intravenous voriconazole was given as salvage therapy for 18 patients; 2 patients received voriconazole as first-line therapy. Median duration of voriconazole treatment was 83.5 days (range, 4-395 days). Global response at end of therapy was satisfactory in 11 (55%) of 20 patients, including complete responses in 4 patients and partial responses in 7 patients; there were no relapses of infection in the 4 patients with complete response to therapy with voriconazole. Treatment was generally well tolerated.
Conclusions:
Long-term voriconazole treatment is a new therapeutic option for invasive aspergillosis with bone involvement.
Insights
Voriconazole demonstrates efficacy in treating invasive bone aspergillosis, a rare fungal infection. Long-term treatment with voriconazole offers a new therapeutic option for patients with bone involvement.
Area of Science:
- Mycology
- Infectious Diseases
- Bone Infections
Background:
- Bone aspergillosis is a rare and severe fungal infection.
- Voriconazole is effective for pulmonary aspergillosis, but its use in bone aspergillosis is not well-established.
Observation:
- This study analyzed 20 cases of invasive bone aspergillosis treated with voriconazole.
- Most patients (14/20) were immunocompromised and received voriconazole as salvage therapy.
- The median treatment duration was 83.5 days.
Findings:
- Voriconazole treatment resulted in a satisfactory global response in 55% of patients (11/20).
- Complete response was observed in 4 patients with no subsequent relapses.
- Treatment was generally well-tolerated.
Implications:
- Long-term voriconazole therapy is a viable treatment option for invasive aspergillosis affecting bone.
- This study expands treatment options for a challenging fungal infection.
- Further research may validate voriconazole's role in bone aspergillosis management.
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