Caspofungin Treatment in Severely Ill, Immunocompromised Patients: A Case-Documentation Study of 118 Patients

J Antimicrob Chemother. 2006 Jan;57(1):127-34. doi: 10.1093/jac/dki410. Epub 2005 Nov 24.

Abstract

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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / adverse effects
  • Antifungal Agents / therapeutic use*
  • Caspofungin
  • Critical Illness
  • Echinocandins
  • Female
  • Germany
  • Humans
  • Immunocompromised Host*
  • Lipopeptides
  • Male
  • Middle Aged
  • Mycoses / drug therapy*
  • Mycoses / immunology
  • Mycoses / mortality
  • Peptides, Cyclic / administration & dosage
  • Peptides, Cyclic / adverse effects
  • Peptides, Cyclic / therapeutic use*
  • Prospective Studies
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Echinocandins
  • Lipopeptides
  • Peptides, Cyclic
  • Caspofungin