Retrospective study of the clinical value of the combination voriconazole (VCZ) / caspofungin (CSP) in the treatment of aspergillosis in lung transplant patients

Thomas A., V. Korb, T. Caruba, R. Guillemain, V. Boussaud, E. Billaud, P. Prognon, D. Begue, B. Sabatier

Abstract: 

Purpose of the study: In theory, the effective plasma concentration (PEC) of VCZ (1mg / L) is reached in 24 hours. In clinical practice, a delay seems necessary in lung transplant patients colonized or infected withAspergillus spp . to reach the CPE VCZ. During this period, treatment with VCZ can be combined with the PUC to cover the infection.

The objectives of this study are to investigate the time required to reach the CPE VCZ cystic fibrosis in transplant patients vs the other patients, the course of infection by Aspergillus spp. and tolerance of the antifungal association.

Methods: The clinical, biological and therapeutic data of lung transplant patients who received the combination VCZ / CSP between 2002 and 2008 in first-line treatment were retrospectively extracted from patient records.

Results: Among the 15 patients studied, A. fumigatus (n = 12) and A. flavus (n = 3) were isolated. CIP VCZ is reached in average 12.3 days (d) (+/- 2.1). The deadline for CF patients (n = 9) of 14.9 j j vs 8.3 for the others (p = 0.10; NS). The average length of treatment is 15.1 d for intravenous VCZ and 18.4 d for the CSP. The cultures of 4 patients for transplant patients Aspergillus colonization were negated and all those treated for aspergillosis had a complete response at 3 months of infection. An increase in the concentration of tacrolimus is observed for 67% of patients, 2 patients had hallucinations and 2 other liver toxicity.

Conclusion: The combination VCZ / CSP is not recommended in the treatment of 1 st line of aspergillosis (IDSA Guidelines 2008) but is used in practice in lung transplant patients with a relatively close tolerance alone VCZ.We observed a period of 12.3 d (vs 24 in theory) to achieve plasma voriconazole> 1mg / l in lung transplant patients. More than a combination, the combination VCZ / CSP would be a way to cover infection by Aspergillus spp. During suboptimal concentrations of VCZ.

2008

Full conference title: 

Réunion Interdisciplinaire de Chimiothérapie Anti Infectieuse
    • RICAI 28th (2008)