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Efficacy and safety of caspofungin in solid organ transplant recipients

Abstract number: 1733_476

Petrovic J., Ngai A., Bradshaw S., Williams-Diaz A., Taylor A., Sable C., Kartsonis N.

Objective: Efficacy & safety data for the echinocandins in solid organ transplant (SOT) recipients are limited. We reviewed the experience from all SOT patients (pts) receiving caspofungin (CAS) therapy (Rx) for an invasive fungal infection (IFI).

Methods: Data in SOT pts receiving CAS are available from 3 clinical trials, including 2 noncomparative clinical trials (a salvage invasive aspergillosis [IA] study [Protocol 019, P019] & a non-fungemic invasive candidiasis [IC] study [P045]) & 1 comparator-controlled study (CAS vs. amphotericin B [AmB] in IC [P014]). CAS was administered at doses ranging from 50 to 100 mg/day. Efficacy was assessed in all pts at end of CAS Rx (EOT). For IC pts, a favourable overall response required complete symptom/sign resolution & Candida eradication (or radiographic resolution). For IA pts, a favourable response required clinically meaningful improvement in attributable symptoms/signs & relevant radiographic findings. Adverse events (AE) & lab data were collected from all pts. Investigators identified the seriousness, causality, & action on study Rx for all clinical & lab AE noted during Rx & for ≥14 days postRx.

Results: 22 SOT pts, aged 34–67 years, were identified. All had proven IC (6 pts) or proven/probable IA (16 pts) & received ≥1 dose of CAS Rx. IC: Mean APACHE II score was 18 (range 6–27). All pts received CAS as primary Rx. Sites of IC included blood (4), peritoneal fluid (1), & liver abscess (1). CAS success at EOT was 83% (5/6), with responses seen across Candida spp. Success by SOT type was kidney 4/5 & liver 1/1. IA: All 16 pts had pulmonary IA (4 definite, 12 probable) & received CAS as salvage Rx. CAS success at EOT was 50% (8/16), with responses seen for both definite (3/4) & probable IA (5/12). Success by SOT type was: heart 2/2, heart/lung 0/2, kidney 3/3, liver 1/3, & lung 2/6. Outcome was not influenced by CAS dose. Safety: CAS, dosed for 2 to 162 (mean 36.8) days, was well tolerated. No pt had a serious drug-related (DR) adverse event (AE) or discontinued CAS due to toxicity. Incidence of DR clinical AE was 9% & DR lab AE 23%. The 30-day overall mortality was 32% (IC 0% & IA 41%).

Conclusion: Based on the limited data, CAS appears to be an effective & well tolerated option for the treatment of IC & IA in SOT recipients.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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