CLINICAL OUTCOMES OF COMBINATION ANTIFUNGAL THERAPY FOR INVASIVE ASPERGILLOSIS: EXPERIENCE AT ONE ACADEMIC CENTER,
Background: Invasive aspergillosis is associated with a high degree of mortality despite the introduction of newer antifungal therapies. Combination antifungal therapy is theoretically appealing and has been used as a treatment modality in spite of the scarcity of clinical evidence, in particular with combining novel agents. Objective: To determine the clinical outcomes and trends with combination antifungal therapy for aspergillosis at Stanford Medical Center. Methods: This study was a retrospective chart review of 996 patients receiving systemic antifungal therapy. During the July 2002 to April 2004 study review period, 47 patients met inclusion criteria for further analysis. Patients met inclusion criteria if they were on combination, systemic antifungals > 5 days and had the possible, probable or definitive diagnosis of invasive aspergillosis. Combination therapy included >2 of any of the following: Amphotericin deoxycholate, Amphotericin Lipid Complex, Liposomal Amphotericin, Itraconazole, Voriconazole or Caspofungin. Data collected was analyzed for clinical response patterns in various patient subtypes. Results: Sixty-six percent of patients (n=31) treated with combination therapy had AML, ALL, or Hodgkinâ€™s. The primary site of infection in treated patients was pulmonary (90%, n=42). Caspofungin combined with Voriconazole was the most common combination used (51%, n=24). The overall success rate for this combination was 75%. This rate of success is the highest reported with any other combination in the literature. The range of success between patient subtypes for this combination was 67-88%. Average time to response was 7 days. Other combination groups possessed too small a sample size for adequate determination of success rates or trends. Conclusion: Larger, prospective trials are warranted to further elucidate the success as well as safety of combination antifungal therapy in aspergillosis. Our data suggests that the combination of voriconazole and caspofungin appears to offer success rates for patients with invasive aspergillosis not seen with any other regimen.
Full conference title:
Advances Against Aspergillosis