Efficacy and safety of high-dose caspofungin in the treatment of invasive pulmonary aspergillosis

Abstract

Objective To investigate the clinical efficacy and safety of high-dose caspofungin (70 mg/d) as initial or salvage treatment for invasive pulmonary aspergillosis. Methods Twenty-one patients with proven or probable invasive pulmonary aspergillosis from June 2014 to October 2017 in Huashan Hospital, Fudan University were retrospectively reviewed. According to the anti-fungal treatment before high-dose caspofungin application, patients were divided into initial treatment group and salvage treatment group. Patients′ clinical data and laboratory data were collected. The characteristics, clinical efficacy, adverse reactions, one-year survival rate and the overall effective rate were evaluated. The prognosis of the two groups was compared by Kaplan-Meier analysis. Results Twenty of the 21 patients opportunistic acquired invasive pulmonary aspergillosis during the treatment of underlying diseases. Five patients were initially treated with high-dose caspofungin for 68 (62) days. At week 12, one patient achieved complete response, 3 patients achieved partial response, and the overall effective rate was 80%(4/5). Sixteen patients received caspofungin as salvage therapy for 66.50 (58) days, of which one patient got complete response at week 12, 10 had partial response, and the overall effective rate was 68.75%(11/16). One-year follow-up showed that no patient died in the initial treatment group, and the one-year survival rate was 100%(5/5). In salvage treatment group, 3 patients died of pulmonary bacterial infections and the one-year survival rate was 81.25%(13/16). During treatment, one patient had elevated total bilirubin, which was possibly associated with high-dose caspofungin. Conclusions High-dose caspofungin regimen has good efficacy and safety, both for initial treatment and salvage therapy in patients with invasive pulmonary aspergillosis. Key words: Invasive pulmonary aspergillosis; Caspofungin; High-dose; Efficacy; Safety