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Published on: March 9, 2018
Retrospective evaluation of caspofungin therapy in invasive aspergillosis (RECAM-IA)
Tami Wisniewski1, Nikolay Klimko, Michel Laverdiere
1Merck & Co, Inc, Whitehouse Station, NJ, USA. tami_wisniewski@merck.com
Abstract:
To evaluate caspofungin in high-risk invasive aspergillosis (IA) patient, a retrospective review of patient characteristics, antifungal therapies and clinical outcomes on hospitalised patients at sites in Russia, Canada, Germany, and Thailand was performed. Fifty-five patients were included, six with proven and 49 with probable aspergillosis; 76.4% had haematological diseases, 80% were on immunosuppressive drugs, 32.7% were neutropenic at caspofungin initiation. Median duration of prior antifungal therapy was 9 days (range 1-232). Reasons for initiating caspofungin included: disease refractory to first-line antifungal (49.1%) and toxicities with prior antifungals (18.2%). Median caspofungin therapy duration was 14 days (range 2-62), with a median of 13 days (range 1-62) as monotherapy. Favourable responses were observed in 45.5% of the patients, complete responses in 40% and partial responses in 5.5%; 74.5% survived 7 days after completion of caspofungin therapy with 69.1% having been successfully discharged from the hospital. Few patients (14.6%) on caspofungin switched because of suspected resistance, lack of response or adverse events. There were no increases in hospital stay as a result of adverse events or drug-drug interactions related to caspofungin; 7.3% of patients had a mean value of 13 (± 14.11) days of increased stay attributable to treatment failure. Caspofungin was well-tolerated. It exhibited effectiveness and high survival in treating severe IA patients.
Insights
Caspofungin demonstrated effectiveness and high survival rates in high-risk patients with invasive aspergillosis (IA). This antifungal agent was well-tolerated, with favorable responses observed in nearly half of the treated individuals.
Area of Science:
- Infectious Diseases
- Mycology
- Clinical Pharmacology
Background:
- Invasive aspergillosis (IA) poses a significant threat to immunocompromised patients.
- Effective and well-tolerated antifungal therapies are crucial for managing high-risk IA cases.
Purpose of the Study:
- To evaluate the effectiveness and tolerability of caspofungin in patients with high-risk invasive aspergillosis.
- To analyze patient characteristics, prior antifungal treatments, and clinical outcomes associated with caspofungin use.
Main Methods:
- Retrospective review of 55 hospitalized patients with proven or probable IA across multiple international sites.
- Analysis of patient demographics, disease severity, immunosuppression status, and prior antifungal exposures.
- Assessment of clinical response, survival rates, and adverse events related to caspofungin therapy.
Main Results:
- 45.5% of patients showed a favorable response to caspofungin, with 40% achieving complete response.
- High survival rates were observed: 74.5% survived 7 days post-therapy, and 69.1% were discharged.
- Caspofungin was generally well-tolerated, with few treatment switches due to adverse events or lack of efficacy.
Conclusions:
- Caspofungin is an effective and well-tolerated treatment option for severe invasive aspergillosis in high-risk patients.
- The study highlights significant survival benefits and favorable clinical outcomes with caspofungin use.
- Caspofungin offers a valuable therapeutic choice, particularly for patients refractory to or intolerant of other antifungals.
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