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Caspofungin Use in Daily Clinical Practice for Treatment of Invasive Aspergillosis: Results of a Prospective Observational Registry.
日常临床实践中卡泊芬净治疗侵袭性曲菌病:前瞻性观测记录结果

出处: BMC Infect Dis   2010   Jun   10 (1) :182

作者:Maertens J;Egerer G;Shik Shin W;Reichert D;Stek M;Chandwani S;Shivaprakash M;Viscoli C;Study Team TC

PMID:20569436

ABSTRACT: BACKGROUND: A prospective observational registry assessed real world experience with caspofungin monotherapy or combination therapy for the initial or salvage treatment of proven or probable invasive aspergillosis (IA). METHODS: Data were collected from April 2006 to September 2007 for patients treated with caspofungin for a single episode of IA. Clinical effectiveness was categorized as favorable (complete or partial) or unfavorable (stable disease or failure) at the end of caspofungin therapy (EOCT). RESULTS: Consecutive patients (n=103) with proven or probable IA (per EORTC/MSG criteria) were identified from 11 countries. Malignancy (76.7%), neutropenia (64.1%), allogeneic hematopoietic stem cell transplantation (HSCT, 22.3%), solid organ transplantation (8.7%), autologous HSCT (4.9%), and HIV/AIDS (2.9%) were the most common underlying conditions. Most patients (84.5%) had pulmonary IA. Aspergillus fumigatus was the most frequently isolated species. The majority of patients received caspofungin monotherapy (82.5%) primarily as salvage therapy (82.4%). The main reason for switching to salvage therapy was clinical failure of the first-line therapy (69%). A favorable response at EOCT was seen in 56.4% (57/101) of patients overall, including 56.5% (48/85) and 56.3% (9/16) of patients receiving caspofungin monotherapy and combination therapy, respectively. Favorable response rates in clinically relevant subgroups were: malignancy, 51.9% (41/79); allogeneic HSCT, 56.5% (13/23); and neutropenia at time of hospitalization, 53.0% (35/66). There was a 72.3% (73/101) survival at 7 days after EOCT. Serious adverse events related to caspofungin were reported in 4 cases (3.9%); 3 patients (2.9%) discontinued treatment due to an adverse event related to caspofungin. CONCLUSIONS: Caspofungin was both effective and well tolerated among high-risk patient groups such as those with neutropenia and active malignancies.

摘要:<br>背景:对于卡泊芬净单一或者联合治疗侵袭性曲菌病确诊及拟诊患者的初始或者补救治疗的真实现状进行前瞻性观察记录。<br>方法:收集2006年4月到2007年9月期间卡泊芬净治疗单独侵袭性曲菌病数据。临床疗效分为卡泊芬净治疗后有效(完全或者部分有效)、无效(疾病稳定无好转或者治疗失败)。<br>结果:来自11个国家的103例确诊或者拟诊侵袭性曲菌病患者入组 (诊断标准为欧洲癌症治疗研究组织/MSG标准),其中恶性肿瘤(76.7%)、中性粒细胞减少(64.1%)、同种异体造血干细胞移植(HSCT, 22.3%),实体器官移植(8.7%), 自体HSCT(4.9%), HIV/AIDS (2.9%)。绝大多数患者(84.5%)患有肺部侵袭性曲菌病。烟曲病是最常见的分离菌属。绝大多数患者接受了卡泊芬净治疗,其中82.5%为单药治疗,82.4%接受补救治疗。进行补救治疗最主要的原因是一线治疗方案失败(69%)。在卡泊芬净治疗结束时 (EOCT),总体有效率为56.4% (57/101),其中单一治疗56.5% (48/85),联合治疗56.3% (9/16)。治疗有效的临床相关亚群为:恶性肿瘤51.9% (41/79),同种异体HSCT 56.5% (13/23),住院期间中性粒细胞减少53.0% (35/66)。EOCT之后7天存活率为72.3% (73/101)。卡泊芬净的严重不良事件为4例(3.9%),3例患者(2.9%) 由于相关不良事件中断治疗。<br>结论:对于具有侵袭性曲菌病高危风险如恶性肿瘤和中性粒细胞减少的患者来说,卡泊芬净具有良好的治疗效果和耐受性。