Prescrire Int. 2002 Oct;11(61):142-3.
(1) Invasive aspergillosis is rare. It usually occurs in immunocompromised patients and is fatal despite treatment in 40-90% of cases. The reference treatments are standard amphotericin B, liposomal amphotericin B, and itraconazole. (2) Caspofungin, an antifungal drug, is now approved in the Europe Union for the treatment of invasive aspergillosis, when reference drugs fail or are poorly tolerated. (3) In a non comparative trial in 69 patients, intravenous caspofungin infusion was at least partly effective: 40% of patients survived with few relapses for at least one year following treatment. A historical comparison also favours caspofungin therapy. (4) The safety profile of caspofungin is poorly documented. It includes local reactions at the injection site, systemic reactions linked to the infusion (especially due to histamine release) and hepatic disorders. (5) Caspofungin is known to interact with tacrolimus (lower tacrolimus concentrations), ciclosporin (increased caspofungin bioavailability) and rifampicin (reduced caspofungin bioavailability). (6) In practice, caspofungin is an acceptable option for the treatment of invasive aspergillosis when standard amphotericin B, liposomal amphotericin B, and itraconazole are ineffective or poorly tolerated. Its clinical assessment is limited and must be continued.
(1) 侵袭性曲霉病较为罕见。它通常发生在免疫功能低下的患者中，尽管进行了治疗，仍有40% - 90%的病例会死亡。参考治疗药物为标准两性霉素B、脂质体两性霉素B和伊曲康唑。(2) 抗真菌药物卡泊芬净目前在欧盟已获批用于治疗侵袭性曲霉病，适用于参考药物治疗失败或耐受性差的情况。(3) 在一项针对69例患者的非对照试验中，静脉输注卡泊芬净至少有部分疗效：40%的患者在治疗后存活且复发较少，至少持续了一年。一项历史对照研究也支持卡泊芬净治疗。(4) 卡泊芬净的安全性记录较少。其不良反应包括注射部位的局部反应、与输液相关的全身反应（尤其是由于组胺释放）以及肝脏疾病。(5) 已知卡泊芬净会与他克莫司相互作用（降低他克莫司浓度）、与环孢素相互作用（增加卡泊芬净的生物利用度）以及与利福平相互作用（降低卡泊芬净的生物利用度）。(6) 在实际应用中，当标准两性霉素B、脂质体两性霉素B和伊曲康唑无效或耐受性差时，卡泊芬净是治疗侵袭性曲霉病的一个可接受选择。其临床评估有限，仍需继续进行。
