Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever

Thomas J. Walsh, Peter Pappas, Drew J. Winston, Hillard M. Lazarus, Finn Petersen, John Raffalli, Saul Yanovich, Patrick Stiff, Richard Greenberg, Gerald Donowitz, Mindy Schuster, Annette Reboli, John Wingard, Carola Arndt, John Reinhardt, Susan Hadley, Robert Finberg, Michél Laverdière, John Perfect, Gary GarberGiuseppe Fioritoni, Eli Anaissie, Jeanette Lee

Research output: Contribution to journalArticle

Abstract

Background: Patients with neutropenia and persistent fever are often treated empirically with amphotericin B or liposomal amphotericin B to prevent invasive fungal infections. Antifungal triazoles offer a potentially safer and effective alternative. Methods: In a randomized, international, multicenter trial, we compared voriconazole, a new second-generation triazole, with liposomal amphotericin B for empirical antifungal therapy. Results: A total of 837 patients (415 assigned to voriconazole and 422 to liposomal amphotericin B) were evaluated for success of treatment. The overall success rates were 26.0 percent with voriconazole and 30.6 percent with liposomal amphotericin B (95 percent confidence interval for the difference, - 10.6 to 1.6 percentage points); these rates were independent of the administration of antifungal prophylaxis or the use of colony-stimulating factors. There were fewer documented breakthrough fungal infections in patients treated with voriconazole than in those treated with liposomal amphotericin B (8 [1.9 percent] vs. 21 [5.0 percent], P=0.02). The voriconazole group had fewer cases of severe infusion-related reactions (P

Original languageEnglish (US)
Pages (from-to)225-234
Number of pages10
JournalNew England Journal of Medicine
Volume346
Issue number4
DOIs
StatePublished - Jan 24 2002
Externally publishedYes

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Neutropenia
Fever
Triazoles
Therapeutics
Colony-Stimulating Factors
Mycoses
Amphotericin B
Multicenter Studies
liposomal amphotericin B
Voriconazole
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

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Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. / Walsh, Thomas J.; Pappas, Peter; Winston, Drew J.; Lazarus, Hillard M.; Petersen, Finn; Raffalli, John; Yanovich, Saul; Stiff, Patrick; Greenberg, Richard; Donowitz, Gerald; Schuster, Mindy; Reboli, Annette; Wingard, John; Arndt, Carola; Reinhardt, John; Hadley, Susan; Finberg, Robert; Laverdière, Michél; Perfect, John; Garber, Gary; Fioritoni, Giuseppe; Anaissie, Eli; Lee, Jeanette.

In: New England Journal of Medicine, Vol. 346, No. 4, 24.01.2002, p. 225-234.

Research output: Contribution to journalArticle

Walsh, TJ, Pappas, P, Winston, DJ, Lazarus, HM, Petersen, F, Raffalli, J, Yanovich, S, Stiff, P, Greenberg, R, Donowitz, G, Schuster, M, Reboli, A, Wingard, J, Arndt, C, Reinhardt, J, Hadley, S, Finberg, R, Laverdière, M, Perfect, J, Garber, G, Fioritoni, G, Anaissie, E & Lee, J 2002, 'Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever', New England Journal of Medicine, vol. 346, no. 4, pp. 225-234. https://doi.org/10.1056/NEJM200201243460403
Walsh, Thomas J. ; Pappas, Peter ; Winston, Drew J. ; Lazarus, Hillard M. ; Petersen, Finn ; Raffalli, John ; Yanovich, Saul ; Stiff, Patrick ; Greenberg, Richard ; Donowitz, Gerald ; Schuster, Mindy ; Reboli, Annette ; Wingard, John ; Arndt, Carola ; Reinhardt, John ; Hadley, Susan ; Finberg, Robert ; Laverdière, Michél ; Perfect, John ; Garber, Gary ; Fioritoni, Giuseppe ; Anaissie, Eli ; Lee, Jeanette. / Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. In: New England Journal of Medicine. 2002 ; Vol. 346, No. 4. pp. 225-234.
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AU - Lazarus, Hillard M.

AU - Petersen, Finn

AU - Raffalli, John

AU - Yanovich, Saul

AU - Stiff, Patrick

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AU - Schuster, Mindy

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AU - Finberg, Robert

AU - Laverdière, Michél

AU - Perfect, John

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AU - Lee, Jeanette

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