Takazono Takahiro, Saito Yoshiyuki, Tashiro Masato, Yoshida Masataka, Takeda Kazuaki, Ide Shotaro, Iwanaga Naoki, Hosogaya Naoki, Sakamoto Noriho, Mukae Hiroshi, Izumikawa Koichi
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Infect Dis Ther. 2025 Jan;14(1):245-259. doi: 10.1007/s40121-024-01094-y. Epub 2024 Dec 26.
Despite the ongoing efforts to refine treatment durations and methods for patients with chronic pulmonary aspergillosis, the clinical use of antifungal agents remains unclear. This study aimed to describe the treatment practices, trajectories, and prognoses of newly diagnosed patients with chronic pulmonary aspergillosis.
Data from a longitudinal database from hospitals in Japan was used. The target population included patients who started antifungal treatment following their initial diagnosis of pulmonary aspergillosis, pulmonary aspergilloma, or chronic necrotizing pulmonary aspergillosis between October 2015 and September 2017. We described patient characteristics and treatment practices.
Of the 680 patients analyzed, 253 (37.2%), 231 (34.0%), 155 (22.8%), 31 (4.6%), and 10 (1.5%) patients received the initial treatment with voriconazole, itraconazole, micafungin, caspofungin, and liposomal amphotericin B, respectively. Over 50% of the patients initially treated with micafungin or caspofungin switched to azoles within a month. Of the patients treated with antifungal agents, only 46.8% continued treatment for 6 months, indicating a lower retention rate. The overall mortality rate at 1 year was 24.7%. The median treatment duration of initial treatment until switching was 83 days (interquartile range [IQR], 159) for voriconazole and 162 days (IQR, 310) for itraconazole, indicating a significant variation in treatment duration. Notably, 15.7% (76/484) of the patients underwent a treatment switch between voriconazole and itraconazole in the initial azole treatment group.
Our findings highlight the challenges associated with sustaining long-term antifungal treatment.
尽管一直在努力优化慢性肺曲霉病患者的治疗时长和方法，但抗真菌药物的临床应用仍不明确。本研究旨在描述新诊断的慢性肺曲霉病患者的治疗实践、病程及预后。
使用来自日本医院纵向数据库的数据。目标人群包括2015年10月至2017年9月期间初次诊断为肺曲霉病、肺曲菌球或慢性坏死性肺曲霉病后开始抗真菌治疗的患者。我们描述了患者特征及治疗实践。
在分析的680例患者中，分别有253例（37.2%）、231例（34.0%）、155例（22.8%）、31例（4.6%）和10例（1.5%）患者最初接受伏立康唑、伊曲康唑、米卡芬净、卡泊芬净和脂质体两性霉素B治疗。最初接受米卡芬净或卡泊芬净治疗的患者中，超过50%在1个月内换用了唑类药物。在接受抗真菌药物治疗的患者中，仅有46.8%持续治疗6个月，表明保留率较低。1年时的总死亡率为24.7%。伏立康唑初始治疗至换药的中位治疗时长为83天（四分位间距[IQR]，159），伊曲康唑为162天（IQR，310），表明治疗时长存在显著差异。值得注意的是，在初始唑类治疗组中，15.7%（76/484）的患者在伏立康唑和伊曲康唑之间进行了治疗转换。
我们的研究结果凸显了长期抗真菌治疗面临的挑战。
