Efficacy of voriconazole combined with caspofungin in treating Chronic Obstructive Pulmonary Disease patients with invasive pulmonary aspergillosis: impacts on clinical outcomes, inflammatory cytokines, and immune markers

Abstract

Objective: To compare the efficacy and safety of voriconazole plus caspofungin versus voriconazole alone in COPD patients with invasive pulmonary aspergillosis (IPA) and to determine whether the combination accelerates symptom resolution, reduces fungal and inflammatory load, and improves lung function and quality of life.

Methodology: We retrospectively analyzed 152 COPD-IPA patients treated between April 2022 and April 2024, divided into an observation group (voriconazole + caspofungin, n=76) and control group (voriconazole alone, n=76). Outcomes included clinical efficacy, symptom resolution, inflammatory markers, and safety.

Results: The observation group demonstrated superior outcomes including higher total efficacy (89.47% vs. 65.79%, P<0.05), faster symptom relief (cough: 5.36 vs. 7.89 days; fever: 7.06 vs. 9.44 days; P<0.05), and shorter hospitalization (12.28 vs. 15.62 days, P<0.05). Post-treatment analysis revealed lower β-D-glucan levels (15.64 vs. 20.16 pg/mL), reduced inflammatory markers (CRP, IL-12, IL-15, IL-17, TNF-α; P<0.05), and improved lung function (FEV1/FVC: 57.56% vs. 54.02%, P<0.05). Quality of life scores significantly improved (P<0.05) with comparable adverse events (7.89% vs. 13.16%, P>0.05).

Conclusion: Voriconazole combined with caspofungin in oral sequential treatment of COPD combined with IPA can accelerate the relief of clinical symptoms and signs of patients, inhibit pathogenic bacteria and inflammatory response, improve lung function and quality of life of patients, improve efficacy, safety and reliability.

Keywords: COPD; caspofungin; combination therapy; invasive pulmonary aspergillosis; voriconazole.