Wednesday, 8 December 2010

Clinical trial examines intravenous micafungin versus voriconazole for chronic pulmonary aspergillosis

The chronic form of aspergillosis is a slowly progressive lung illness caused by Aspergillus infection. There have been many clinical case reports on the treatment of CPA and also a few retrospective studies.
The Infectious Diseases Society of America recommends oral azoles as primary therapy for CPA, but data from large scale clinical trials have not been available.
The use of intravenous antifungal treatment as induction therapy, followed by oral antifungals as a maintenance therapy, have now been trialed in a larger group of CPA patients in Japan (Kohno et al 2010) as reported in the Journal of Infection.
In this drug trial, intravenous micafungin was compared with intravenous voriconazole as induction therapy for 2 weeks in CPA patients needing immediate treatment. A total of 107 patients were studied.
Clinical effectiveness was defined by clinical, mycological, radiological and serological responses.
The study indicated no difference in efficacy between the two IV drugs but fewer adverse effects occurred in the micafungin group than with IV voriconazole. The overall treatment success rate for both drugs was around 60%.

The take home message is that there was not much difference between the efficacy of micafungin and voriconazole intravenously - but the side effects of micafungin were less severe and less frequent - meaning that more patients could be successfully treated with micafungin (IV) as a primary therapy for CPA.

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