Objectives: To analyze clinical features of chronic pulmonary aspergillosis (CPA)in patients with underlying chronic respiratory disease, and to evaluate the efficacy and tolerability of voriconazole against CPA in those patients. Methods: Voriconazole therapy was indicated in 45 CPA patients between October 2005 and September 2007, in 23 patients as first-line treatment and in 22 after lack of response or intolerance to prior antifungal agent. Clinical characteristics of CPA including serological findings were retrospectively and observationally analyzed. Clinical and radiological improvement was assessed during and after treatment. Plasma concentration of voriconazole was monitored in 14 patients. Results: Most common underlying respiratory disease was sequelae of tubercu-losis (n=23) followed by COPD (n=13). Galactomannan antigen test was positive in 29 of 43 patients (67%), while 28 patients out of 36 (78%) were positive for serum antibody against Aspergillus. Positive mycological result was found in 15 patients. Clinical and/or radiological improvement was obtained in 30 patients with voriconazole therapy of average duration 4.8 months, though definitive control of the disease was not frequently achieved as much. The main adverse effects were visual disturbance (31%) and hepatotoxicity (28%). The average plasma trough level was 2.5μg/ml and the correlation between dose and levels was weak. All patients who developed liver dysfunction had plasma trough level higher than 4μg/ml. Conclusions: Voriconazole demonstrated good efficacy and tolerability against CPA. Monitoring plasma concentration of voriconazole may be beneficial to predict hepatic toxicity.
Full conference title:
19th European Respiratory Society Annual Congress
- ERS 19th (2009)