卡泊芬净在侵袭性曲霉病治疗中的临床应用：一项前瞻性观察性注册研究结果。
Caspofungin use in daily clinical practice for treatment of invasive aspergillosis: results of a prospective observational registry.
机构信息
UZ Gasthuisberg, Leuven, Belgium.
出版信息
BMC Infect Dis. 2010 Jun 22;10:182. doi: 10.1186/1471-2334-10-182.
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.
背景
一项前瞻性观察性登记研究评估了卡泊芬净单药或联合治疗方案在确诊或疑似侵袭性曲霉病（IA）初始或挽救治疗中的真实世界经验。
方法
该研究于 2006 年 4 月至 2007 年 9 月期间，对接受卡泊芬净单药治疗的 IA 单例患者进行了数据收集。在卡泊芬净治疗结束时（EOCT），根据临床疗效将患者分为有利（完全或部分）或不利（病情稳定或失败）。
结果
从 11 个国家中确定了符合确诊或疑似 EORTC/MSG 标准的 IA 连续患者（n=103）。恶性肿瘤（76.7%）、中性粒细胞减少症（64.1%）、异基因造血干细胞移植（HSCT，22.3%）、实体器官移植（8.7%）、自体 HSCT（4.9%）和 HIV/AIDS（2.9%）是最常见的基础疾病。大多数患者（84.5%）患有肺部 IA。烟曲霉是最常分离的物种。大多数患者接受卡泊芬净单药治疗（82.5%），主要是作为挽救治疗（82.4%）。转为挽救治疗的主要原因是一线治疗的临床失败（69%）。在所有患者中，EOCT 时观察到有利反应的比例为 56.4%（57/101），包括卡泊芬净单药和联合治疗的患者比例分别为 56.5%（48/85）和 56.3%（9/16）。在具有临床意义的亚组中，有利反应率为：恶性肿瘤，51.9%（41/79）；异基因 HSCT，56.5%（13/23）；中性粒细胞减少症住院时，53.0%（35/66）。EOCT 后 7 天的生存率为 72.3%（73/101）。有 4 例（3.9%）报告了与卡泊芬净相关的严重不良事件；3 例（2.9%）因与卡泊芬净相关的不良事件而停止治疗。
结论
卡泊芬净在中性粒细胞减少症和活动性恶性肿瘤等高危患者群体中既有效又耐受良好。
Zotero 插件