Voriconazole (VRC) Therapy (Rx) in 86 Patients (pts) with CNS Aspergillosis (CNSA): a Retrospective Analysis.

P.F. TROKE, S. SCHWARTZ, M. RUHNKE, P. RIBAUD, L. COREY, T. DRISCOLL, G. FÄTKENHEUER, U. SCHULER, E. THIEL, B. DODELL, I. LUTSAR

Author address: 

Pfizer Ltd., Sandwich, United Kingdom, Univ. Clin. Benjamin Franklin, Berlin, Germany, Charité Humboldt Univ., Berlin, Germany, St. Louis Hosp., Paris, France, Fred Hutchinson Cancer Ctr., Seattle, WA, Duke Univ. Med. Ctr., Durham, NC, Med. Clin. Uni

Abstract: 

A total of 51 males and 35 females (9m - 81 y.o.) with definite or probable CNSA were given VRC Rx, including 46 with biopsy +ve brain or CSF. Brain/other biopsies yielded A. fumigatus 34 pts, A. nidulans 5, aspergillus spp 24. Underlying conditions were BMT (33 pts), hematologic malignancy (14) solid organ transplant (12), acquired/congenital immunosuppression (15), other (12). Only 13/86 pts received primary VRC Rx (2600d]. Investigators assessed a complete/partial response in 34% (VRC Rx; median 222d, range 8 - 1128) and stable/failed response in 66% (VRC Rx: median 18d, range 1 - 514). Underlying condition impacted response and survival (15% response in BMT but 42 - 50% all others; known survival - 21% BMT, 14% hematologic malignancy, 33% - 67% all others). Death day from starting VRC was known for 59 pts (median 33d, range 3 - 418) and death was ascribed to fungal infection in 39 (66%). Known survival duration for the remaining 27 pts was median 222d (range 10 - 1128). There were 518 all causality adverse events (AEs) in 78/86 pts (91%). The investigators ascribed most to underlying condition or CNSA, but 67 (13%) AEs in 34pts were considered possibly VRC-related. Most common VRC-related AEs were raised LFTs (13pts), visual events (8) and rash (7). In 21 pts where Rx was discontinued due to AEs, they were VRC-related in 7 (elevated LFTs 3pts, cutaneous eruption 1, acute pancreatitis 1, bone marrow aplasia 1, tachyarrythmia 1). VRC is a promising Rx for CNS aspergillosis.
2003

abstract No: 

M-1755

Full conference title: 

43rd Interscience Conference on Antimicrobial Agents
    • ICAAC 43rd