A RETROSPECTIVE REVIEW OF CLINICAL OUTCOMES IN PATIENTS
RECEIVING CASPOFUNGIN
Neil Masters, Haematology Pharmacist, Queen Elizabeth Hospital,
Birmingham
Neil Masters
Haematology Pharmacist
Pharmacy Department
Queen Elizabeth Hospital
Edgbaston
Birmingham
B15 2TH
Tel 0121 627 2323
Fax 0121 627 2324
neil.masters@uhb.nhs.uk
A RETROSPECTIVE REVIEW OF CLINICAL OUTCOMES IN PATIENTS
RECEIVING CASPOFUNGIN
Neil Masters, Pharmacy department, Queen Elizabeth Hospital, Birmingham
Introduction
Invasive fungal infections are a major cause of morbidity and mortality in patients
undergoing allogeneic and autologous stem cell transplantation.
Caspofungin is second line antifungal agent within our haematology unit for patients
who are unresponsive or intolerant of Abelcet. There is evidence to suggest that
caspofungin is at least as effective as conventional amphotericin B in the treatment of
invasive candidasis1, and liposomal amphotericin B as empirical therapy for patients
with pyrexia of unknown origin2.
As part of continuing review of the units’ antifungal policy, it was deemed necessary
to assess the efficacy, and tolerability of Caspofungin in our patients. This review
would also identify if use of Caspofungin was within the policy recommendations.
Methods
In this retrospective audit we aim to collect data from 20 patients who have received
at least 2 doses of Caspofungin within the last year to 18 months. The relevant
clinical data was collected by the haematology pharmacist from patient’s clinical
notes.
Results/Discussion
Between March 2005 and June 2006, 21 patients were identified as having received
at least 2 doses of Caspofungin (mean 8.5 days). On 13 occasions Caspofungin was
chosen as first-line treatment (raised creatinine n=11). On 9 occasions Caspofungin
was second-line treatment (increased creatinine n= 4, intolerance of Abelcet n=2).
As a result there were 1 complete response, and 5 partial responses (27% response
rate). 3 patients had no response, and on13 occasion’s fungal infection was ruled
out. No patients discontinued Caspofungin due to adverse events.
The audit suggests from this group of patients that Caspofungin is being selected as
antifungal therapy as per the unit policy. The drug appears well tolerated in our group
of patients with little dose-limiting toxicity. Unfortunately comment on its efficacy in
this group would not be prudent due to the large number of patients where invasive
fungal infection was not present.
References
1. Mora-Duarte J et al. (2002) Comparison of caspofungin and amphotericin B for
invasive candidiasis. New England Journal of Medicine 347(25): 2020-9.
2. Walsh TJ et al (2004) Caspofungin versus liposomal amphotericin B for empirical
antifungal therapy in patients with persistent fever and neutropenia. New England
Journal of Medicine 351(14): 1391-1402.