| BackgroundThe diagnosis and treatment of invasive fungal infections has become intensively focused on for its growing prevalence in recent years. Invasive pulmonary aspergillosis, as a very common invasive fungal disease with unified standard for diagnosis, lacks a normative medicine choice and use. Currently voriconazole and caspofungin are widely used for treatment of invasive pulmonary aspergillosis, but the problem of too late intervention and too short course to get a favorable response does exist widely in clinical practice. So to evaluate and compare the effect and safety of these two agents and analysis of different strategies may provide guidelines to selection of antifungal agents and methods.PurposeThe therapeutic effects on invasive pulmonary aspergillosis and tolerance of voriconazole and caspofungin were evaluated and compared in this study; the efficacy of treatments under different levels of diagnosis, ages, courses of therapy and risk levels were also assessed and compared.MethodsThis study retrospectively analyzed 81 cases who met the diagnostic and treatment criteria for invasive pulmonary fungal infections (draft), diagnostic and treatment criteria for invasive fungal infections of hematopathy and malignancy patients (3rd edition) or diagnostic and treatment criteria for invasive fungal infections of severe cases (2007) and received antifungal therapy in Qilu Hospital affiliated to Shandong University from January 2009 to January 2011. Among them 48 cases were given voriconazole and 22 were administrated with caspofungin. The proportion of favorable responses and adverse reactions of the two groups were calculated to estimate the effectiveness and safety.The cases were separated by the diagnostic levels when antifungal therapy was given to three groups:definitive therapy(proven diagnosis), preempirical therapy(probable diagnosis) and empirical therapy(possible diagnosis). The effective rate of each group was computed and compared.Cases aged over 65 were divided to elderly group and others were divided to non-elderly group. The favorable rates of two groups treated with two agents were compared. Assess and compare the efficiency of therapy courses longer than 11 days and those shorter than 10 days.Score all cases treated with voriconazole according to the multi-disease risk assessment program by West Virginia University Hospital, and compare the effectiveness rate and fatality rate of different risk levels.ResultsThe effective rates of voriconazole group and caspofungin group were 23.5%and 33.3%, respectively (P=0.4388), and the adverse reaction rate of caspofungin group was significantly lower than voriconazole group. (3.3%vs.21.3%, P=0.0355)Different levels of diagnosis:the favorable rates of preempirical and empirical treatment in voriconazole group were 28.0%and 19.2%(.P=0.5230), and those of caspofungin were 36.8%and 27.3%(P=0.7020), respectively.Different levels of age:comparisons between effective rates of elderly group and non-elderly group in voriconazole group (13.6%vs.31.0%) and caspofungin group (20.0%vs. 46.7%) showed no significant difference(P=0.1496 and 0.1213, respectively). And no significance in statistics was seen when comparing the effective rates of voriconazole and caspofungin in either elderly group or non-elderly group (P=0.6696 and 0.3069, respectively).Differences lengths of course:significant differences existed between the favorable rates of long term group and short term group administrated with caspofungin (88.9%vs.10.5%, P<0.0001), but that didn't exist between two groups treated with voriconazole(41.2%vs. 14.7%, P=0.0763)Different MRDA scores:among patients treated with voriconazole, when setting 15 as a cut-off, effective percentage of low risk group was significantly higher than high risk group(44.4%vs.12.1%,,P=0.0153); when setting 25 as a cut-off, the fatality rate of high risk group (60.0%) was significantly higher than low risk group (9.8%)(P=0.0018).ConclusionsVoriconazole and caspofungin are efficacious and safe agents for invasive pulmonary aspergillosis therapy, caspofungin has a better tolerance and might have a higher effective rate than voriconazole.Preempirical therapy may gain a better favorable rate than empirical therapy, and antifungal agents should be used with referring to valuable microbiological reports.When treating patients aged over 65 years old, voriconazole and caspofungin may not be a better choice than each other. Long term use of antifungal agents contributes to a better response.Long course of caspofungin treatment is essential for antifungal therapy.MDRA scoring by WVUH makes a very limited sense as guidelines for antifungal prophylaxis but plays an important role in estimating the prognosis of IPA patients. |
PDF Full Text Request