Wednesday, 24 July 2013

Antifungal Therapy Improved Outcomes for Chronic Pulmonary Aspergillosis

The latest research carried out at the National Aspergillosis Centre in Manchester, UK with the aid of over a hundred patients has been published. This research is made far stronger by the involvement and enthusiasm of our patients.

Al-shair et al. (2013) have conducted a detailed study comparing the long term use of different antifungals to treat Chronic Pulmonary Aspergillosis (CPA) patients. Assessments were taken quarterly over 12 months.
It should be noted that patients with untreated CPA usually experience deterioration of their health, so the fact that the researchers recorded an overall 68 - 71% of patients either stabilising or improving is hugely encouraging. This outcome was consistent even with those who were most ill when starting antifungal therapy.

Quoting from the paper:
"Mean age was 59 years and 45% were female. Overall, patients with CPA had substantial health status impairment at baseline. After treatment, 47-50% gained substantial health improvement with a reduction of score of 14 at both 6 and 12 months, while 32% deteriorated with a rise of 11 and 14 scores after 6 and 12 months of treatment and observation respectively, and 21% were not much different (stable).
Patients gained therapeutic benefit irrespective of their illness severity where >50% of those who had “poor” and “very poor” at baseline improved with reduction of ≥4 scores after 6 months of treatment. Replicating this analysis using much wider scale, we found that at least 50% of “poor/very poor” health status category at baseline improved significantly to “fair” or “good/very good” categories."
Other conclusions in the paper were that posaconazole gave slightly better outcomes compared with voriconazole, and voriconazole was a little better than itraconazole

Quoting from the paper:
“Posaconazole (Noxafil, Merck) appeared slightly better than voriconazole (Vfend, Pfizer) which in turn was better than itraconazole (Sporanox, Janssen/Ortho Biotech); 50% and 62% of our patients were improved after 6 and 12 months of posaconazole, compared with 43% and 50% with voriconazole and 39% and 43% with itraconazole.”

These results are strong and very encouraging  for the future treatment of this form of aspergillosis with antifungal drugs.

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