Efficacy of caspofungin as salvage therapy for invasive aspergillosis compared to standard therapy in a historical cohort

J. W. Hiemenz, I. I. Raad, J. A. Maertens, R. Y. Hachem, A. J. Saah, C. A. Sable, J. A. Chodakewitz, M. E. Severino, P. Saddier, R. S. Berman, D. M. Ryan, M. J. Dinubile, T. F. Patterson, D. W. Denning, T. J. Walsh

Research output: Contribution to journalArticle

Abstract

In a non-comparative study, caspofungin was effective salvage therapy for approximately half of the patients refractory to or intolerant of standard antifungal agents for invasive aspergillosis. To establish a frame of reference for these results, we compared the response to caspofungin with responses to other antifungal agents in a historical cohort of similar patients. The efficacy could be evaluated in 83 patients who received caspofungin 50 mg daily after a 70-mg loading dose. The historical control group, identified through a retrospective review of medical records, included 214 evaluable patients possibly refractory to or intolerant of ≥1 week of standard antifungal therapy. All patients had documented invasive aspergillosis. Favorable response was defined as a complete or partial response to therapy. Underlying diseases, baseline neutropenia, corticosteroid use, and sites of infection were similar in both studies. Most patients had received amphotericin B formulations and/or itraconazole, and were refractory to standard therapy. Favorable response rates were 45% with caspofungin and 16% with standard therapy. The unadjusted odds ratio for a favorable response (caspofungin/standard therapy) was 4.1 (95% confidence interval: 2.2, 7.5). After adjusting for potential imbalances in the frequency of disseminated infection, neutropenia, steroid use, and bone marrow transplantation between groups, the odds ratio remained at 4.1 (2.1, 7.9). Although only tentative conclusions about relative efficacy can be drawn from retrospective comparisons, caspofungin appeared to be at least as efficacious as an amphotericin B formulation and/or itraconazole for the treatment of invasive aspergillosis in patients refractory to or intolerant of their initial antifungal therapy.

Original languageEnglish (US)
Pages (from-to)1387-1394
Number of pages8
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume29
Issue number11
DOIs
StatePublished - Nov 1 2010

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Hiemenz, J. W., Raad, I. I., Maertens, J. A., Hachem, R. Y., Saah, A. J., Sable, C. A., Chodakewitz, J. A., Severino, M. E., Saddier, P., Berman, R. S., Ryan, D. M., Dinubile, M. J., Patterson, T. F., Denning, D. W., & Walsh, T. J. (2010). Efficacy of caspofungin as salvage therapy for invasive aspergillosis compared to standard therapy in a historical cohort. European Journal of Clinical Microbiology and Infectious Diseases, 29(11), 1387-1394. https://doi.org/10.1007/s10096-010-1013-0