title: Voriconazole treatment for less-common, emerging, or refractory fungal infections.
abstract: Treatments for invasive fungal infections remain unsatisfactory. We evaluated the efficacy, tolerability, and safety of voriconazole as salvage treatment for 273 patients with refractory and intolerant-to-treatment fungal infections and as primary treatment for 28 patients with infections for which there is no approved therapy. Voriconazole was associated with satisfactory global responses in 50% of the overall cohort; specifically, successful outcomes were observed in 47% of patients whose infections failed to respond to previous antifungal therapy and in 68% of patients whose infections have no approved antifungal therapy. In this population at high risk for treatment failure, the efficacy rates for voriconazole were 43.7% for aspergillosis, 57.5% for candidiasis, 38.9% for cryptococcosis, 45.5% for fusariosis, and 30% for scedosporiosis. Voriconazole was well tolerated, and treatment-related discontinuations of therapy or dose reductions occurred for <10% of patients. Voriconazole is an effective and well-tolerated treatment for refractory or less-common invasive fungal infections.
authors.affiliation: Department of Medicine and Microbiology, Duke University Medical Center, Durham, North Carolina 27710, USA. perfe001@mc.duke.edu
authors.forename: John R
authors.initials: JR
authors.lastname: Perfect
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: Richard N
authors.initials: RN
authors.lastname: Greenberg
authors.forename: Bertrand
authors.initials: B
authors.lastname: DuPont
authors.forename: Juliàn
authors.initials: J
authors.lastname: de la Torre-Cisneros
authors.forename: Gudrun
authors.initials: G
authors.lastname: Just-Nübling
authors.forename: Haran T
authors.initials: HT
authors.lastname: Schlamm
authors.forename: Irja
authors.initials: I
authors.lastname: Lutsar
authors.forename: Ana
authors.initials: A
authors.lastname: Espinel-Ingroff
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy*; D002177:Candidiasis / Q000188:drug therapy*; D002648:Child; D006801:Humans; D008875:Middle Aged; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole