By Ed Susman
SAN FRANCISCO -- September 15, 2009 -- Treatment of non-albicans Candida infections with caspofungin appears as successful as treatment for Candida albicans, researchers stated here at the 49th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC).
"We were concerned about whether caspofungin would be as successful again the non-albicans species of Candida, especially since in our area of Brazil, Candida parapsilosis is 1 of the major infections," said Arnaldo Colombo, MD, Universidade Federal, São Paulo, Brazil.
Dr. Colombo and colleagues examined 5 clinical trials and investigated how well caspofungin worked in achieving eradiation of the fungal infections in individuals with non-albicans species.
"We observed that caspofungin demonstrated excellent efficacy across all non-albicans Candida species," he said at his poster presentation on September 13.
"Candida albicans remains the most common pathogen in invasive candidiasis," he said. "However, an increasing number of candidiasis cases are due to non-albicans species such as Candida glabrata, Candida guilliermondii, Candida krusei, Candida lusitaniae, Candida parapsilosis, and Candida tropicalis."
In the studies, 167 patients were identified with C albicans infections while 212 patients were identified with infections with other Candida species, including 71 individuals infected with C parapsilosis.
"Particular concerns have been raised in using echinocandins to treat invasive candidiasis caused by C parapsilosis," Dr. Colombo said. "However, these studies show that the success rate among patients with a C parapsilosis infection was high. The time to bloodstream clearance of infection and the rate of relapse were comparable in patients with C parapsilosis infection and those with other Candida infections."
For example, he noted that 2 of 48 patients who were cured of their C parapsilosis infection relapsed within a 2-week follow-up period compared with 4 of 107 patients who had cleared C albicans infections -- a 4% rate of relapse in both groups.
About half the patients in the studies were men, about half the patients in the studies had undergone major surgery, ~25% were under treatment for an active malignancy, more than three-fourths of the patients were at risk of a fungal infection due to treatment with broad spectrum antibiotics, and about 40% of the patients who developed the Candida infections had been receiving parenteral nutrition.
About 30% of the patients who developed Candida infections -- more than 70% of which were bloodstream infections -- died. About 29% of the C albicans patients died compared with 20% of the C parapsilosis infected patients.
Dr. Colombo said that use of caspofungin resulted in few serious drug-related toxicities or the need to suspend the medication due to toxicity.
[Presentation title: Caspofungin (CAS) Efficacy in Invasive Candidiasis (IC) Due to Non-albicans Candida Species (NACS). Abstract M-1035]
E-Mail this DGDispatch to a colleague
