title: Efficacy of caspofungin and itraconazole as secondary antifungal prophylaxis: analysis of data from a multinational case registry.
abstract: Patients surviving invasive fungal disease (IFD) and needing further antineoplastic chemotherapy are at high risk of recurrent fungal infection. In the absence of randomised controlled trials in this area, secondary prophylactic regimens are diverse. From 448 patients registered with the Multinational Case Registry of Secondary Antifungal Prophylaxis, we performed an analysis of patients receiving caspofungin (CAS) or itraconazole (ITC). All patients had an underlying haematological malignancy and had been diagnosed with an episode of IFD earlier in their course of treatment. Data collected comprised demographics, underlying disease, first episode of IFD, antifungal prophylaxis, incidence and outcome of breakthrough IFD and survival. A total of 75 patients were evaluated, comprising 28 receiving CAS and 47 receiving ITC. Patients in the CAS group were more likely to have had progression of underlying disease (32.1% vs. 8.5%; P=0.028) as well as incomplete response of initial IFD at baseline (85.7% vs. 57.4%; P=0.005). Allogeneic stem cell transplantation was more prevalent in patients receiving CAS (46.4% vs. 14.9%; P=0.010). There was no difference in the occurrence of breakthrough IFD between both groups (32.1% vs. 31.9%). Treatment outcomes for recurrent IFD and overall mortality did not differ between groups. Both ITC and CAS were equally effective in preventing second episodes of IFD. Patients with uncontrolled first IFD, uncontrolled underlying disease or those receiving stem cell transplantation were more likely to have received CAS prophylaxis. Despite antifungal prophylaxis, risk of breakthrough IFD was high in both groups.
authors.affiliation: Klinik I für Innere Medizin, Klinikum der Universität zu Köln, Cologne, Germany.
authors.forename: Jörg J
authors.initials: JJ
authors.lastname: Vehreschild
authors.forename: Michal
authors.initials: M
authors.lastname: Sieniawski
authors.forename: Stefan
authors.initials: S
authors.lastname: Reuter
authors.forename: Dorothee
authors.initials: D
authors.lastname: Arenz
authors.forename: Dietmar
authors.initials: D
authors.lastname: Reichert
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.forename: Angelika
authors.initials: A
authors.lastname: Böhme
authors.forename: Gerda
authors.initials: G
authors.lastname: Silling
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Georg
authors.initials: G
authors.lastname: Maschmeyer
authors.forename: Maria J G T
authors.initials: MJ
authors.lastname: Rüping
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Ullmann
authors.forename: Oliver A
authors.initials: OA
authors.lastname: Cornely
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D000077336:Caspofungin; D018890:Chemoprevention / Q000379:methods*; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D012042:Registries / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D017964:Itraconazole; D000077336:Caspofungin