JAC Advance Access originally published online on November 24, 2005
Journal of Antimicrobial Chemotherapy 2006 57(1):127-134; doi:10.1093/jac/dki410
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Caspofungin treatment in severely ill, immunocompromised patients: a case-documentation study of 118 patients
1 Medizinische Klinik und Poliklinik I, University of Bonn, Germany; 2 Klinik I für Innere Medizin, University of Köln, Germany; 3 Innere Medizin III, University of Ulm, Germany; 4 Zentrum Innere Medizin, Abt. für Nephrologie und Rheumatologie, University of Göttingen, Germany; 5 Medizinische Klinik und Poliklinik III, University of Frankfurt, Germany; 6 Innere Medizin A—KMT-Zentrum, University of Münster, Germany; 7 Klinik für Hämatologie, Onkologie und Klinische Immunologie, University of Düsseldorf, Germany; 8 Med. Klinik und Poliklinik V, University of Heidelberg, Germany; 9 Institut für Pathologie und Mikrobiologie, Städtisches Krankenhaus Kiel, Kiel, Germany; 10 Med. Klinik und Poliklinik I, University of Dresden, Germany; 11 Medizinische Klinik I, Krankenhaus Köln-Merheim, Germany; 12 Innere Klinik und Poliklinik, University of Essen, Germany; 13 Universitäts-Kinderklinik, University of Münster, Germany; 14 Med. Klinik 5, Klinikum Nürnberg, Germany; 15 Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, University of Tübingen, Germany
Received 18 May 2005; returned 12 August 2005; revised 7 October 2005; accepted 14 October 2005
* Correspondence address. Department of Internal Medicine I, University of Bonn, 53105 Bonn, Germany. Tel: +49-228-287-5507; Fax: +49-228-287-5849; E-mail: glasmacher{at}uni-bonn.de
Background: Caspofungin has shown efficacy in empirical antifungal therapy in neutropenic patients, refractory invasive Aspergillus infections and invasive candidiasis. Here we report the currently largest series of patients treated with caspofungin outside clinical trials.
Methods: Centres in Germany that were known to treat patients with invasive fungal infections were asked to fill out detailed questionnaires for all patients treated with caspofungin. No effort was made to influence the decision to use caspofungin.
Results: A total of 118 patients were evaluable (median age 48 years, interquartile range 38–58), out of which 41 (35%) suffered from acute leukaemia, 31 (26%) had allogeneic stem cell transplants, 16 (14%) lymphoma or myeloma, 8 (7%) autologous stem cell transplants and 22 (19%) other causes for immunosuppression. One hundred and six patients were evaluable for efficacy out of which 68 (64%) patients achieved a complete or partial remission. A total of 81 out of 115 (70%) patients were alive 30 days after the end of caspofungin therapy. Response rates were similar in proven (20/32, 63%) and probable (27/46, 59%) infections, in neutropenic patients (41/55, 75%) and in patients who were (44/70, 63%) or were not (24/36, 67%) refractory to antifungal pre-treatment. The response rate in mechanically ventilated patients was 29% (7/24). Caspofungin was well tolerated, even in 14 patients, who were concomitantly treated with ciclosporin A, no drug-related elevations of bilirubin, alanine aminotransferase or creatinine were found.
Conclusions: This open case study of severely ill patients with invasive fungal infections demonstrates both excellent efficacy and very low toxicity of caspofungin.
Keywords: fungal infections , candidiasis , aspergillosis , safety
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