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Shibata Y, Miyahara Y, Sadaka Y, Yasue M, Fujimura M, Soda M, Yamamoto M, Kato H, Suzuki A, Tsukamoto K, Hara T, Tsurumi H, Kitaichi K. Evaluation of the effectiveness of caspofungin against febrile neutropenia and the factors related to the alteration in its plasma concentration. J Infect Chemother 2019; 25:801-805. [PMID: 31047782 DOI: 10.1016/j.jiac.2019.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Abstract
Caspofungin (CPFG) is an echinocandin antifungal agent that inhibits the synthesis of β-1, 3-D-glucan, a critical component of the cell wall of target fungi. Several clinical studies have confirmed the efficacy and safety of CPFG in patients with febrile neutropenia (FN); however, there are no reports available in Japanese patients with FN. Therefore, we investigated the therapeutic efficacy and pharmacokinetics of CPFG as an empirical therapy in a Japanese hospital. Twenty-four Japanese patients, who were diagnosed with FN at Gifu University Hospital from February 2014 to August 2017, were enrolled. Blood samples were collected at the end of CPFG dosing (0.5 h after the infusion) on day 1 and immediately prior to the next infusion on days 2, 3, and 4. The concentration of CPFG in plasma was measured by high-performance liquid chromatography. The efficacy was assessed by five of the component endpoints, and safety was monitored according to the Common Terminology Criteria for Adverse Events. CPFG showed an excellent effect against FN (75%, 18/24), without any serious hepatic or renal toxicity. Regarding the pharmacokinetics, the plasma concentration of CPFG was significantly correlated with body weight; although, no correlation was observed between the plasma concentration of CPFG and the other factors investigated, such as gender or laboratory results. These results suggest the high efficacy, safety, and tolerability of CPFG as an empirical antifungal therapy for Japanese patients with FN.
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Affiliation(s)
- Yuhei Shibata
- Department of Hematology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan; Department of Hematology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu, 500-8513, Japan
| | - Yuri Miyahara
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Yuna Sadaka
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Mika Yasue
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Minami Fujimura
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Midori Soda
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Miho Yamamoto
- Global Regulatory Science, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Hiroko Kato
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Katsura Tsukamoto
- Global Regulatory Science, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan
| | - Takeshi Hara
- Department of Hematology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan; Department of Hematology, Matsunami General Hospital, Dendai 185-1, Kasamatsu-cho, Hasima-gun, Gifu, 501-6062, Japan
| | - Hisashi Tsurumi
- Department of Hematology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan; Department of Hematology, Matsunami General Hospital, Dendai 185-1, Kasamatsu-cho, Hasima-gun, Gifu, 501-6062, Japan
| | - Kiyoyuki Kitaichi
- Laboratory of Pharmaceutics, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan.
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Della Pepa R, Picardi M, Sorà F, Stamouli M, Busca A, Candoni A, Delia M, Fanci R, Perriello V, Zancanella M, Nosari A, Salutari P, Marchesi F, Pane F, Pagano L. Successful management of chronic disseminated candidiasis in hematologic patients treated with high-dose liposomal amphotericin B: a retrospective study of the SEIFEM registry. Support Care Cancer 2016; 24:3839-45. [PMID: 27075673 PMCID: PMC4967093 DOI: 10.1007/s00520-016-3208-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/03/2016] [Indexed: 12/29/2022]
Abstract
Purpose Chronic disseminated candidiasis (CDC) is a complication of Candida infection in immunocompromised patients, involving the liver and spleen, and rarely other organs. The aim of the study is to identify the best antifungal drug for hematologic immunocompromised patients with CDC. Methods In this multicentric retrospective study, the charts of 20 patients with CDC following cytotoxic agent protocols for hematological malignancies, diagnosed from 2003 to 2013, were analyzed. The response to systemic antifungal therapy within 90 days from CDC diagnosis and the possible delay in chemotherapy plan, due to the infection, were evaluated. Results Six patients were treated with high-dose (HD; 5 mg/kg/daily) liposomal amphotericin B (L-AmB), whereas three received standard-dose (SD) L-AmB (3 mg/kg/daily). Azoles were given to six patients; the remaining five were treated with echinocandins. All patients treated with HD L-AmB (6/6—100 %) achieved complete resolution of CDC; one of them had to interrupt the chemotherapy program for the infection. In the SD L-AmB group, treatment failed in the 100 % of cases and one patient had to delay chemotherapy for the infection. Of the six patients who received azoles, two achieved complete resolution of the infection, four experienced treatment failure, and only three performed chemotherapy as planned. Echinocandins treatment resulted in complete resolution of the infection in 2/5 cases, partial response in 2/5 cases, and failure in one case. In this group, 3/5 patients completed chemotherapy as planned. Conclusions This study shows that HD L-AmB was particularly effective against CDC in hematologic patients, allowing most patients to continue cytotoxic agent program.
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Affiliation(s)
- Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy.
| | - M Picardi
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy
| | - F Sorà
- Hematology Catholic University Sacro Cuore, Rome, Italy
| | - M Stamouli
- Hematology Catholic University Sacro Cuore, Rome, Italy
| | - A Busca
- Hematology Le Molinette Hospital, Torino, Italy
| | - A Candoni
- Hematology University of Udine, Udine, Italy
| | - M Delia
- Hematology University of Bari, Bari, Italy
| | - R Fanci
- Hematology University of Firenze, Florence, Italy
| | - V Perriello
- Hematology University of Perugia, Perugia, Italy
| | | | - A Nosari
- Hematology Niguarda Hospital, Milan, Italy
| | - P Salutari
- Hematology Pescara Hospital, Pescara, Italy
| | - F Marchesi
- Haematology, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - F Pane
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy
| | - L Pagano
- Hematology Catholic University Sacro Cuore, Rome, Italy
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Newer antifungal agents for fungal infection prevention during hematopoietic cell transplantation: a meta-analysis. Transplant Proc 2013; 45:407-14. [PMID: 23375330 DOI: 10.1016/j.transproceed.2012.07.149] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 07/19/2012] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The efficacy of newer antifungal agents to provide effective prophylaxis during stem cell transplantation has not yet been established. We compared the clinical outcomes using of the newer triazoles and echinocandins for antifungal prophylaxis. METHODS We electronically searched the databases of Cochrane Central Register of Controlled Trials, Pubmed, EMBASE, and relevant articles from 1987 through 2011. We examined comparative studies for survival, proven fungal infections, mortality, and adverse effects. Our meta-analysis was performed by Review Manager 5.1.6 software with funnel plot regression analysis to assess publication bias. RESULTS Among 1443 records were 17 studies including 5122 patients for analyses. Pooled comparisons of studies showed antifungal prophylaxis with the new agents to reduce the incidence of invasive fungal infections greater than fluconazole or itraconazole. A reduction in invasive fungal infections was achieved using micafungin, voriconazole, and posaconazole for antifungal prophylaxis. Posaconazole and voriconazole prophylaxis decreased transplant mortality compared with fluconazole or itraconazole prophylaxis. Voriconazole and posaconzole showed greater rates of liver dysfunction and lower incidences gastrointestinal side effects than fluconazole. Caspofungin and voriconazole treatment incurred lower rates of nephrotoxic effects than amphotericin B. Only voriconazole displayed significantly decreased adverse events requiring drug discontinuation compared with fluconazole or itraconazole. CONCLUSIONS This analysis indicated new antifungal agents were well-tolerated with manageable side effects. They were beneficial for prophylaxis of invasive fungal infections.
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Miceli MH, Chandrasekar P. Safety and efficacy of liposomal amphotericin B for the empirical therapy of invasive fungal infections in immunocompromised patients. Infect Drug Resist 2012; 5:9-16. [PMID: 22294858 PMCID: PMC3269132 DOI: 10.2147/idr.s22587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Liposomal amphotericin B is a “true” liposomal formulation of amphotericin B with greatly reduced nephrotoxicity and minimal infusion-related toxicity. This broad spectrum polyene is well tolerated and effective against most invasive fungal infections. In view of the current limitations on diagnostic capability of invasive fungal infections, most clinicians are often compelled to use antifungal drugs in an empiric manner; liposomal amphotericin B continues to play an important role in the empiric management of invasive fungal infections, despite the recent availability of several other drugs in the azole and echinocandin classes.
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Krishnan-Natesan S, Manavathu EK, Cutright JL, Chandrasekar PH. Efficacy of anidulafungin, caspofungin and fluconazole in the early phase of infection in a neutropenic murine invasive candidiasis model. Int J Antimicrob Agents 2010; 36:33-6. [PMID: 20400270 DOI: 10.1016/j.ijantimicag.2010.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 11/20/2009] [Accepted: 02/13/2010] [Indexed: 10/19/2022]
Abstract
In this study, we investigated the in vivo efficacy of anidulafungin during the early phase of disseminated candidiasis in a neutropenic murine model and compared the results with those obtained for fluconazole. Antifungal efficacy was evaluated by reduction of fungal burden in the tissues of infected animals at periodic intervals during the first day of treatment. The fungal burden in tissues of drug-treated mice was reduced compared with controls in a time-dependent manner. At 24h after drug treatment, a >2 log(10) reduction of fungal burden in the kidney was obtained in the anidulafungin- and caspofungin-treated mice compared with a ca. 1.2 log(10) reduction in fluconazole-treated mice (P<0.003). There was no significant difference in the splenic fungal burden at 24h. Thus, echinocandins have excellent antifungal activity in the early phase of disseminated Candida albicans infection and may contribute to an improved outcome in critically ill immunocompromised/neutropenic patients.
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Characterisation of breakthrough invasive mycoses in echinocandin recipients: an evidence-based review. Int J Antimicrob Agents 2010; 35:211-8. [DOI: 10.1016/j.ijantimicag.2009.09.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 09/22/2009] [Accepted: 09/29/2009] [Indexed: 11/17/2022]
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Murali S, Langston A. Advances in antifungal prophylaxis and empiric therapy in patients with hematologic malignancies. Transpl Infect Dis 2009; 11:480-90. [DOI: 10.1111/j.1399-3062.2009.00441.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Drug interactions and adverse events associated with antimycotic drugs used for invasive aspergillosis in hematopoietic SCT. Bone Marrow Transplant 2009; 45:1197-203. [PMID: 19946342 DOI: 10.1038/bmt.2009.325] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study was to assess the frequency of potential drug-drug interactions (pDDIs) and adverse drug events (ADEs) associated with antimycotics in hospitalized patients with hematopoietic SCT (HSCT). Of the 120 HSCT recipients evaluated, 36 received antimycotics. A total of 124 ADEs were recorded in 32 of the 36 patients treated, with 54 ADEs being possibly and 9 probably related to antimycotics. Of the treatments with amphotericin B, 93% were associated with one or more possible and 36% with probable ADEs. The corresponding figures for lipid-based amphotericin B were 100% and 7%, for voriconazole 68% and 11% and for caspofungin 70% and 0%. A total of 57 potentially severe DDIs associated with antimycotics were detected in 31 of the 36 patients. Of these, 14 DDIs were a possible cause of an ADE and 5 (4 times a combination of voriconazole with CYA and once a combination of CYA with conventional amphotericin B) were probably related. Although the prevalence of pDDIs and ADEs is high in HSCT patients, ADEs related with a high probability to treatment with antimycotics are rare. Regarding the high prevalence of pDDIs, our findings underscore the importance of close monitoring of laboratory and clinical parameters, as well as dose adjustment for critical drugs, in patients with HSCT.
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Espinel-Ingroff A, Canton E, Martin-Mazuelos E, Pemán J. Pharmacotherapy of Candida Infections with Echinocandins. ACTA ACUST UNITED AC 2009. [DOI: 10.4137/cmt.s2311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The classic recommended antifungal agents for the treatment of invasive Candida infections were amphotericin B, a lipid formulation of amphotericin B and fluconazole in both neutropenic or nonneutropenic patients as either primary or alternative therapies. Voriconazole has been recommended when additional coverage for filamentous fungi is needed (e.g. neutropenic patients). More recently and based on well designed comparative clinical trials, the three echinocandins, caspofungin, anidulafungin and micafungin have been added as primary or alternative therapies especially for critically ill or neutropenic patients. In general, the echinocandins are most useful when patients have previously been exposed to an azole or are unstable.
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Affiliation(s)
| | - Emilia Canton
- Unidad de Microbiología Experimental, Centro de investigación, Hospital Universitario La Fe, valencia, Spain
| | | | - Javier Pemán
- Servicio de Microbiología, Hospital Universitario La Fe, Valencia, Spain
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Vener C, Carrabba M, Fracchiolla NS, Costa A, Fabio G, Hu C, Sina C, Guastella C, Pignataro L, Deliliers GL. Invasive fungal sinusitis: An effective combined treatment in five haematological patients. Leuk Lymphoma 2009; 48:1577-86. [PMID: 17701590 DOI: 10.1080/10428190701457923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Invasive fungal rhinosinusitis (IFR) is a life-threatening infection. Its onset is subtle and a late diagnosis leads to severe complications. Death may occur within a few weeks notwithstanding treatment. We describe a comprehensive pre- and post-operative approach to care for haematological patients with IFR. Five haematological patients with IFR were treated with systemic antifungal therapy and endoscopic surgical debridement of infected tissues, followed by amphotericin-B directly instilled in the sinuses by a new type of ethmoidal drainage. The IFR remitted in all cases; after 32 months of follow-up, three patients are still alive, and two have died of other causes. Two of the patients who experienced IFR progression to the brain at the IFR onset are still alive. The pharmacological and surgical approach with the post-operative local therapy by a new ethmoidal drainage system could support radical antifungal sinus treatment, thus improving the overall survival.
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Affiliation(s)
- Claudia Vener
- U.O. Ematologia I, Centro Trapianti di Midollo, Università degli Studi di Milano & Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico, Mnagiagalli e Regina Elena, Milano, Italy
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Poon LM, Chia HY, Tan LK, Liu TC, Koh LP. Successful intensive chemotherapy followed by autologous hematopoietic cell transplantation in a patient with acute myeloid leukemia and hepatosplenic candidiasis: case report and review of literature. Transpl Infect Dis 2009; 11:160-6. [DOI: 10.1111/j.1399-3062.2009.00363.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
This review summarizes the current status and diagnostic-therapeutic challenges in febrile neutropenia. Patients with neutropenia-associated infections have a poor prognosis. A large meta-analysis of trials assessing prophylactic antibiotics has shown significant survival benefits; clinical significance of resistance is unclear. Administering broad-spectrum antibiotics to established febrile neutropenic patients has become selective, vancomycin is withheld unless absolutely necessary, and low-risk patients are identified with biological markers. Such patients are now managed with oral antibiotics at home or even without antibiotics. Protracted prolonged neutropenia is the setting par excellence for invasive fungal infections. Conventional amphotericin B administered to such risk patients reduces the incidence of fungal infections. New antifungal drugs have heightened efficacy and lowered toxicity. Novel antifungal diagnostic tests include imaging, particularly the CT "halo" sign (aspergillosis), and serology (glucan, galactomannan), and provide earlier diagnosis and treatment and better outcomes. Negative tests may indicate withholding antifungal therapy. High intermittent dosing of liposomal amphotericin B seems as safe and as effective as standard dosing regimens, but at half the drug acquisition cost. The use of nonantibiotic agents has offered alternative management strategies. Recombinant interleukin-11 reduces bacteremia, through a cytoprotective mechanism on the gut. rhIL-11 releases C-reactive protein and causes shedding of soluble TNF receptor-1, modulating the immunological milieu and the systemic inflammatory response. Other candidate molecules include RANTES and long-pentraxin 3. Recombinant growth factors reduce febrile episodes, permitting completion of chemotherapy, increase overall survival, and minimize infection mortality.
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Affiliation(s)
- Michael Ellis
- Department of Medicine, Faculty of Medicine and Health Sciences, Tawam-Johns Hopkins and Al Ain Hospitals, Al Ain, United Arab Emirates.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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