Voriconazole (Vori) Use for Endemic Fungal Infections (EFI)

ALISON FREIFELD, MD1, LAURIE A. PROIA, MD2, DAVE R. ANDES, MD3, LARRY M. BADDOUR, MD4, JANIS E. BLAIR, MD5, BRAD SPELLBERG, MD6, SANDRA R. ARNOLD, MD7, ARNOLD LENTNEK, MD8, L. JOSEPH WHEAT, MD9;

Author address: 

1University of Nebraska Medical Center, Omaha, NE, 2Rush Medical College, Chicago, IL, 3University of Wisconsin, Madison, WI, 4Mayo Clinic, Rochester, MN, 5Mayo Clinic, Phoenix, AZ, 6Geffen School of Medicine at UCLA, Torrence, CA, 7University of

Abstract: 

Background: Vori has in vitro activity against endemic fungi but has not been studied clinically. In the absence of clinical trial data, vori is occasionally used to treat EFI if other drugs are unfeasible. Methods: To assess its utility, we report 25 proven or probable EFI cases from 8 U.S. hospitals, in whom vori was used therapeutically. A case report included demographics, EFI diagnosis, underlying disease, antifungal treatments, and outcomes. Results: EFI cases were histoplasmosis (histo; 9), blastomycosis (blasto; 9) and coccidiodomycosis (cocci; 7) among 15 men and 10 women, mean 45 yrs old (158722;71 yrs). There were 9 solid organ and 1 stem cell transplant pts, 8 other immunosuppressed and 7 normal hosts. EFI was local pulmonary vs disseminated in 7 and 18 pts, respectively. Vori was primary therapy in 2 pts (1 histo/1 blasto); 23 pts had vori secondarily, after a median of 42 d on other antifungals. Intolerance/toxicity (17/23) and failure (6/23) were reasons for switch to vori. Median duration vori was 234 days (221797 d). Six pts stopped vori (1 due to toxicity, 2 with possible therapeutic failure, 2 due to high drug cost) after median 107 d on drug. At 3 months after starting vori, 22/24 reported EFI pts were stable or improved; only 2 cocci pts were worse. First-line vori therapy was used in 1 histo case with excellent response, and 1 blasto case who died after prolonged treatment. Five deaths occurred: 3 blasto, 2 cocci, after median 84 d on vori. Survival was 20/25 cases (6/9 blasto, 5/7 cocci, 9/9 histo) with vori use as part of the antifungal regimen. Conclusions: These data suggest a useful role for oral vori in maintenance treatment of EFI.
2006

abstract No: 

572

Full conference title: 

Infectious Diseases Society of America, 44th Annual Meeting
    • IDSA 44th