Retrospective evaluation of caspofungin therapy in invasive aspergillosis (RECAM-IA)

• Published in: Mycoses Vol. 54; no. 4; pp. e148 - e153
• Main Authors: Wisniewski, Tami, Klimko, Nikolay, Laverdiere, Michel, Kiertiburanakul, Sasisopin, Kliasova, Galina, Trenschel, Rudolf, Kumar, Ritesh N.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-07-2011
• Subjects: Antifungal; Antifungal Agents - administration & dosage; Antifungal Agents - adverse effects; Aspergillosis; Aspergillus; Canada; Caspofungin; Echinocandins - administration & dosage; Echinocandins - adverse effects; Female; Germany; Hematologic Neoplasms - complications; Hospitals; Humans; Immunocompromised Host; Immunosuppressive agents; Immunosuppressive Agents - administration & dosage; invasive aspergillosis; Invasive Pulmonary Aspergillosis - drug therapy; Lipopeptides; Male; Neutropenia; outcomes; RECAM; Retrospective Studies; Risk groups; Russia; Survival; Survival Analysis; Thailand; Time Factors; Toxicity; Treatment Outcome
• ISSN: 0933-7407; 1439-0507
• DOI: 10.1111/j.1439-0507.2010.01861.x

Summary
To evaluate caspofungin in high‐risk invasive aspergillosis (IA) patient, a retrospective review of patient characteristics, antifungal therapies and clinical outcomes on hospitalised patients at sites in Russia, Canada, Germany, and Thailand was performed. Fifty‐five patients were included, six with proven and 49 with probable aspergillosis; 76.4% had haematological diseases, 80% were on immunosuppressive drugs, 32.7% were neutropenic at caspofungin initiation. Median duration of prior antifungal therapy was 9 days (range 1–232). Reasons for initiating caspofungin included: disease refractory to first‐line antifungal (49.1%) and toxicities with prior antifungals (18.2%). Median caspofungin therapy duration was 14 days (range 2–62), with a median of 13 days (range 1–62) as monotherapy. Favourable responses were observed in 45.5% of the patients, complete responses in 40% and partial responses in 5.5%; 74.5% survived 7 days after completion of caspofungin therapy with 69.1% having been successfully discharged from the hospital. Few patients (14.6%) on caspofungin switched because of suspected resistance, lack of response or adverse events. There were no increases in hospital stay as a result of adverse events or drug–drug interactions related to caspofungin; 7.3% of patients had a mean value of 13 (±14.11) days of increased stay attributable to treatment failure. Caspofungin was well‐tolerated. It exhibited effectiveness and high survival in treating severe IA patients.