Caspofungin: new preparation. A last resort in invasive aspergillosis.

(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.