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JAC Advance Access originally published online on March 24, 2004
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Journal of Antimicrobial Chemotherapy (2004) 53, 878-881
© 2004 The British Society for Antimicrobial Chemotherapy

Second-line therapy with caspofungin for mucosal or invasive candidiasis: results from the caspofungin compassionate-use study

Nicholas A. Kartsonis*, Alfred Saah, C. Joy Lipka, Arlene Taylor and Carole A. Sable

Merck Research Laboratories, West Point, PA, USA

Received 28 August 2003; returned 21 January 2004; revised 30 January 2004; accepted 10 February 2004

Objectives: To prospectively assess the efficacy and safety of caspofungin as second-line therapy for mucosal or invasive candidiasis in patients enrolled in the caspofungin compassionate-use study.

Materials and methods: Thirty-seven patients with mucosal or invasive candida infections (17 oesophageal, four oropharyngeal and 16 invasive candidiasis) were enrolled in the caspofungin compassionate-use study. All patients were refractory to or intolerant of intravenous amphotericin B or lipid amphotericin formulation(s). Efficacy was assessed at the end of intravenous caspofungin therapy based on clinical (and, where appropriate, microbiological) response.

Results: HIV was the most common (91%) risk factor in patients with mucosal candidiasis; patients with invasive candidiasis commonly had acute leukaemia/lymphoma (50%) or diabetes mellitus (31%). Most patients with mucosal candidiasis (91%) and invasive candidiasis (94%) were refractory to >=1 antifungal agent(s). A favourable response was noted in 82% (14/17) with oesophageal candidiasis, 100% (4/4) with oropharyngeal candidiasis and 87% (13/15) with invasive candidiasis. Caspofungin was generally well tolerated; one serious drug-related adverse event was reported.

Conclusion: In this study, caspofungin was an effective alternative for patients with refractory candida infections.

Keywords: Candida, echinocandins, novel antifungal treatment

* Corresponding author. Tel: +1-484-344-7301; E-mail: nicholas_kartsonis{at}merck.com


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