Pulsed echinocandin therapy in azole intolerant or multiresistant chronic pulmonary aspergillosis: A retrospective review at a UK tertiary centre. (5th March 2020)

• Record Type: Journal Article
• Authors: Osborne, William; Fernandes, Michelle; Brooks, Sophie; Grist, Emily; Sayer, Charlie; Hansell, David M.; Wilson, Robert; Shah, Anand; Loebinger, Michael R.
• Is Part Of: Clinical respiratory journal. Volume 14:Number 6(2020)
• Page Start: 571
• Page End: 577
• Publication Date: 2020-03-05
• Subjects: azoles -- caspofungin -- CPA -- drug resistance -- echinocandins -- fungal -- pulmonary aspergillosis; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 616.24
• DOI: 10.1111/crj.13171
• Languages: English
• ISSNs: 1752-6981

Abstract

Abstract: Introduction: Chronic pulmonary aspergillosis (CPA) is a fungal disease with high mortality and morbidity. Guidelines suggest treatment with azoles as first‐line therapy. However, patients often develop treatment intolerance or increasingly azole resistance. Objectives: This retrospective review assesses outcomes in azole resistant or intolerant patients with CPA treated with cyclical echinocandin therapy. Methods: We retrospectively examined records of 25 patients with CPA treated with cyclical caspofungin, 6 of whom were either azole‐resistant or azole intolerant. Baseline characteristics, high‐resolution computed tomography severity scores, forced expiratory volume after 1 minute (FEV1), forced vital capacity (FVC), body mass index and serology ( Aspergillus fumigatus‐ specific IgG, Aspergillus fumigatus‐ specific IgE, total IgE and CRP) were assessed before and after caspofungin. Results: Of the six patients, four (66%) started caspofungin due to intolerance and two (33%) due to pan‐azole resistance. On treatment, there was stability in FEV1 with an overall mortality of 33% during the follow‐up period with a median survival of 875.5 days (IQR 529‐1024). No significant change in serology ( A. fumigatus ‐specific IgG and CRP was seen. Conclusions: With pulsed echinocandin therapy, azole‐intolerant or pan‐resistant CPA patients have similar mortality rates to azole‐naïve CPA patients. Pulsed echinocandin therapy may present a strategy to stabilize CPA in patients with pan resistance or intolerance to, azole therapy.