Voriconazole for invasive bone aspergillosis: a worldwide experience of 20 cases.
BACKGROUND; Bone aspergillosis remains a rare but potentially devastating fungal disease. Although voriconazole is effective for invasive pulmonary aspergillosis, evidence of its efficacy for aspergillosis located in bone is limited.


METHODS
We report our experience with voriconazole in 4 cases of invasive bone aspergillosis. In addition, all cases of probable and definite bone aspergillosis from the Pfizer clinical database were reviewed and analyzed to determine the safety and efficacy of voriconazole treatment. Global response was evaluated at the end of therapy on the basis of a composite assessment of overall clinical, radiological, and mycological responses.


RESULTS
Twenty patients are described, of whom 18 had definite bone involvement diagnosed (spondylodiskitis in 9, sternum/rib osteomyelitis in 6, and peripheral bone involvement in 5). Of 20 patients, 14 were immunocompromised. Oral or intravenous voriconazole was given as salvage therapy for 18 patients; 2 patients received voriconazole as first-line therapy. Median duration of voriconazole treatment was 83.5 days (range, 4-395 days). Global response at end of therapy was satisfactory in 11 (55%) of 20 patients, including complete responses in 4 patients and partial responses in 7 patients; there were no relapses of infection in the 4 patients with complete response to therapy with voriconazole. Treatment was generally well tolerated.


CONCLUSIONS
Long-term voriconazole treatment is a new therapeutic option for invasive aspergillosis with bone involvement.
Mouas
Houria
H
Service des Maladies Infectieuses et Tropicales, Hôpital Necker, Paris, France.
Lutsar
Irja
I
Dupont
Bertrand
B
Fain
Olivier
O
Herbrecht
Raoul
R
Lescure
Francois-Xavier
FX
Lortholary
Olivier
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy*; D002675:Child, Preschool; D006801:Humans; D008875:Middle Aged; D010000:Osteitis / Q000188:drug therapy* / Q000382:microbiology; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use*; D016879:Salvage Therapy; D013166:Spondylitis / Q000188:drug therapy* / Q000382:microbiology; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole