title: Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy.
abstract: BACKGROUND
  Invasive aspergillosis (IA) is an important cause of morbidity and mortality among immunocompromised patients. Echinocandins are novel antifungal molecules with in vitro and in vivo activity against Aspergillus species.
  
  
  METHODS
  We investigated the efficacy and safety of caspofungin in the treatment of IA. Ninety patients with IA who were refractory to or intolerant of amphotericin B, lipid formulations of amphotericin B, or triazoles were enrolled to receive caspofungin.
  
  
  RESULTS
  Efficacy was assessed for 83 patients who had infection consistent with definitions of IA and who received >or=1 dose of study drug. Common underlying conditions included hematologic malignancy (48% of patients), allogeneic blood and marrow transplantation (25% of patients), and solid-organ transplantation (11% of patients). Seventy-one patients (86%) were refractory to and 12 patients (14%) were intolerant of previous therapy. A favorable response to caspofungin therapy was observed in 37 (45%) of 83 patients, including 32 (50%) of 64 with pulmonary aspergillosis and 3 (23%) of 13 with disseminated aspergillosis. Two patients discontinued caspofungin therapy because of drug-related adverse events. Drug-related nephrotoxicity and hepatotoxicity occurred infrequently.
  
  
  CONCLUSIONS
  Caspofungin demonstrated usefulness in the salvage treatment of IA.
authors.affiliation: University Hospital, Gasthuisberg, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.forename: Issam
authors.initials: I
authors.lastname: Raad
authors.forename: George
authors.initials: G
authors.lastname: Petrikkos
authors.forename: Marc
authors.initials: M
authors.lastname: Boogaerts
authors.forename: Dominik
authors.initials: D
authors.lastname: Selleslag
authors.forename: Finn B
authors.initials: FB
authors.lastname: Petersen
authors.forename: Carole A
authors.initials: CA
authors.lastname: Sable
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Kartsonis
authors.forename: Angela
authors.initials: A
authors.lastname: Ngai
authors.forename: Arlene
authors.initials: A
authors.lastname: Taylor
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Patterson
authors.forename: David W
authors.initials: DW
authors.lastname: Denning
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy*; D000077336:Caspofungin; D054714:Echinocandins; D005260:Female; D006801:Humans; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D000077336:Caspofungin