Clinical Citations: Antifungal therapy for pulmonary aspergillosis: The results of 2 studies

Two recent studies provide encouraging data about the effectiveness of voriconazole in the treatment of aspergillosis. One study found that voriconazole was effective in the management of subacute invasive aspergillosis and chronic pulmonary aspergillosis. The other study found that it was beneficial in the treatment of chronic cavitary pulmonary aspergillosis.

Subacute invasive aspergillosis

Sambatakou and associates conducted an open, noncomparative multicenter study that included 36 patients who had profound neu-tropenia. Twenty-one patients had subacute invasive aspergillosis, and 15 had chronic pulmonary aspergillosis. Voriconazole was given as primary therapy for 21 patients and as salvage therapy for 14. The regimen was 200 mg twice daily for 4 to 24 weeks; the dosage could be increased if the patient's response to therapy was suboptimal.

A complete or partial response occurred in 43% of patients with subacute invasive aspergillosis. Improvement or stability occurred in 80% of patients with chronic pulmonary aspergillosis. The most common adverse events were liver function abnormalities, skin reactions, and visual disturbances; these were mild and transient and required the discontinuation of therapy in 5 patients.

Chronic cavitary pulmonary aspergillosis

Jain and Denning conducted a retrospective noncomparative study of 16 patients who had chronic cavitary pulmonary aspergillosis. In all 16 cases, itraconazole therapy had failed or patients were intolerant of such therapy. The participants were subsequently treated with oral voriconazole.

The duration of therapy ranged from 3 days to 16.5 months. Eleven patients received therapy for at least 3 months without having any adverse events.

At 3 months, a reduction in inflammatory markers, such as C- reactive protein level and erythrocyte sedimentation rate, or improvement in pulmonary symptoms occurred in 64% of patients. Aspergillus precipitins were quantitated by numbers of arcs and serum dilution; 11 patients (100%) demonstrated improvement of at least 1 band or fall of titer. Therapy failed in 2 patients and had to be discontinued as a result of adverse events in 5.