Second-line therapy with caspofungin for mucosal or invasive candidiasis: results from the caspofungin compassionate-use study.
OBJECTIVE
To prospectively assess the efficacy and safety of caspofungin as second-line therapy for mucosal or invasive candidiasis in patients enrolled in the caspofungin compassionate-use study.


METHODS
Thirty-seven patients with mucosal or invasive candida infections (17 oesophageal, four oropharyngeal and 16 invasive candidiasis) were enrolled in the caspofungin compassionate-use study. All patients were refractory to or intolerant of intravenous amphotericin B or lipid amphotericin formulation(s). Efficacy was assessed at the end of intravenous caspofungin therapy based on clinical (and, where appropriate, microbiological) response.


RESULTS
HIV was the most common (91%) risk factor in patients with mucosal candidiasis; patients with invasive candidiasis commonly had acute leukaemia/lymphoma (50%) or diabetes mellitus (31%). Most patients with mucosal candidiasis (91%) and invasive candidiasis (94%) were refractory to >/=1 antifungal agent(s). A favourable response was noted in 82% (14/17) with oesophageal candidiasis, 100% (4/4) with oropharyngeal candidiasis and 87% (13/15) with invasive candidiasis. Caspofungin was generally well tolerated; one serious drug-related adverse event was reported.


CONCLUSIONS
In this study, caspofungin was an effective alternative for patients with refractory candida infections.
Kartsonis
Nicholas A
NA
Merck Research Laboratories, West Point, PA, USA. nicholas_kartsonis@merck.com
Saah
Alfred
A
Lipka
C Joy
CJ
Taylor
Arlene
A
Sable
Carole A
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D000077336:Caspofungin; D025141:Drug Resistance, Fungal; D054714:Echinocandins; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use*; D010456:Peptides, Cyclic; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010455:Peptides; D010456:Peptides, Cyclic; D000077336:Caspofungin