Keywords
Voriconazole
Caspofungin
Amphotericin B
Caspofungin
Amphotericin B
How to Cite
Lima, S. A. M., Bonfim, J. R. de A., Campos, E. R., & Nascimento, A. de F. (2013). Voriconazole and caspofungin versus amphotericin in the treatment of aspergillosis in high-risk patients: hematologic malignancies, febrile neutropenia or undergoing transplantation in general. Boletim Do Instituto De Saúde - BIS, 14(2), 205–212. Retrieved from https://periodicos.saude.sp.gov.br/bis/article/view/34134
Abstract
Background: Amphotericin B is the antifungal agent used in the Brazilian Public Health System (SUS) for the treatment of invasive fungal infection (IFI). New antifungal agents are being selected with little epidemiological definition and high cost. Objective: To conduct health technology assessment on the safety and efficacy of voriconazole (VOR) and Caspofungin (CAS) versus Amphotericin (AmB) in the treatment of aspergillosis in high-risk patients: hematologic malignancies, febrile neutropenia or undergoing transplantation in general. Methods: It was conducted searches of articles in Trip Database, PubMed, LILACS and Cochrane. The words used were voriconazole, caspofungin, amphotericin, aspergillus and fusarium. Outcomes: survival, response to therapy and discontinuation of treatment. Results: The primary analysis considered 3 systematic reviews and 4 clinical trials. The auxiliary analysis considered 6 articles (2 observational studies and 4 economic evaluations), 2 guidelines and 2 editorial articles. Conclusion: The VOR and CAS are not inferior to AmB. There is evidence of superiority of these two drugs in some specific conditions. It’s essential new diagnostic techniques for early and specific treatment decision for patients with IFI, because there is greater efficacy and safety in the use of antifungal agents in patients with proven infection.
References
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2. De Pauw B, Donnelly J. Editorial. Prophylaxis and aspergillosis: has the principle been proven? N Engl J Med. 2007; 356(4): 409-11. [ Links ]
3. Del Bono V, Mikulska M, Viscoli C. Invasive aspergillosis: diagnosis, prophylaxis and treatment. Curr Opin Hematol. 2008; 15:586–93 [ Links ]
4. Díaz Pedroche C, Cisneros JM, Lumbreras C, Aguado JM, Grupo Clinico Espanol de Estudio de Voriconazol. Treatment of invasive fungal infections with voriconazole. Evaluation of experience with compassionate use of voriconazole in Spain. Rev Esp Quimioter [periódico na internet]. 2005 [acesso em 7 mar 2013];18(2):149-58. Disponível em http://www.seq.es/seq/0214-3429/18/2/149.pdf [ Links ]
5. Dominguez-Gil A, Martin I, Garcia Vargas M, Del Castillo A, Diaz S, Sanchez C. Economic evaluation of voriconazole versus caspofungin for the treatment of invasive aspergillosis in Spain. Clin Drug Invest. 2007; 27(3):197-205. [ Links ]
6. Freemantle N, Tharmanathan P, Herbrecht R. Systematic review and mixed treatment comparison of randomized evidence for empirical, pre-emptive and directed treatment strategies for invasive mould disease. J Antimicrob Chemother [periódico na internet]. 2011 [acesso em 7 fev 2013];66(Suppl1):i25–35. Disponível em: http://jac.oxfordjournals.org/content/66/suppl_1/i25.full.pdf+html [ Links ]
7. Garbino J, Schnetzler G, Roberts C. Invasive aspergillosis: is treatment with ‘inexpensive’ amphotericin B cost-saving if ‘expensive’ voriconazole is only used on demand. Swiss Med Wkly [periódico na internet]. 2006 [acesso em 7 fev 2013]; 136(39-40):624-630. Disponível em: http://www.smw.ch/docs/pdf200x/2006/39/smw-11259.pdf [ Links ]
8. Herbrecht R, Denning DW, Patterson TF, Bennett, J. E., Greene, R. E., Oestmann, J. W.et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med [periódico na internet]. 2002 [acesso em 7 fev 2013];347:408-15. Disponível em: http://www.nejm.org/doi/pdf/10.1056/NEJMoa020191 [ Links ]
9. Herbrecht R, Maertens J, Baila L, Aoun M, Heinz W, Martino R, et al. Caspofungin first-line therapy for invasive aspergillosis in allogeneic hematopoietic stem cell transplant patients: an European Organisation for Research and Treatment of Cancer study. Bone Marrow Transpl [periódico na internet]. 2010 [acesso em 7 fev 2013];45:1227-33. Disponível em: http://www.nature.com/bmt/journal/v45/n7/pdf/bmt2009334a.pdf [ Links ]
10. Jørgensen KJ, Gøtzsche PC, Johansen HK. Voriconazole versus amphotericin B in cancer patients with neutropenia. Cochrane Database of Systematic Reviews [base de dados na internet];10, Art. No. CD004707. DOI: 10.1002/14651858.CD004707.pub1. Ano 2009. [acesso em 23 dez 2011]. Disponível em: http://cochrane.bvsalud.org/cochrane/show.php?db=reviews&mfn=2791&id=CD004707&lang=pt&dblang=&lib=COC&print=yes
11.Kim A, Nicolau DP , Kuti JL. Hospital costs and outcomes among intravenous antifungal therapies for patients with invasive aspergillosis in the United States. Mycoses. 2011; 54: e301–e312. [ Links ]
12. Kontoyiannis DP, Marr KA, Park BJ, Alexander BD, Anaissie EJ, Walsh TJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis [periódico na internet]. 2010 [acesso em 7 fev 2013];50:1091-100. Disponível em: http://cid.oxfordjournals.org/content/50/8/1091.full.pdf+html [ Links ]
13. Lortholary O, Gangneux JP, Sitbon K, Lebeau B, Monbrison F, Le Strat Y, et al. . Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005-2007). Clin Microbiol Infect [periódico na internet]. 2011 [acesso em 7 fev 2013]; 17(12):1882-1889. Disponível em: http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03548.x/pdf [ Links ]
14. Miceli MH, Lee SA. Emerging moulds: epidemiological trends and antifungal resistance. Mycoses. 2011. 54, e666–e678. [ Links ]
15. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica e Insumos Estratégicos. Formulário terapêutico nacional 2010: Rename 2010 [monografia na internet]. 2. ed. Brasília (DF); 2010. 1135 p. (Série B. Textos básicos de saúde). [acesso em 12 dez 2011]. Disponível em: http://portal.saude.gov.br/portal/arquivos/pdf/FTN_2010.pdf.
16. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes metodológicas: elaboração de pareceres técnico-científicos [monografia na internet]. 3.ed.rev.atual. Brasília (DF); 2011. 62 p. (Série A. Normas e manuais técnicos). [acesso em 23 jun 2012]. Disponível em: http://200.214.130.94/rebrats/publicacoes/DiretrizesPTC.pdf
17. Neofytos D, Horn D, Anaissie E, Marr KA, Olyaei A. Epidemiology and outcome of invasive fungal infection in adult haematopoetic stem cell transplant recipients: analysis of multicentre Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis [periódico na internet]. 2009 [acesso em 7 fev 2013]; 48:265-73. Disponível em: http://cid.oxfordjournals.org/content/48/3/265.full.pdf+html [ Links ]
18. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica [periódico na internet]. 2006 [acesso em 7 fev 2013];91:1068-75. Disponível em:http://www.haematologica-thj.org/content/91/8/1068.full.pdf [ Links ]
19. Prentice AG, Glasmacher A, Hobson RP, Schey S, Barnes RA, Donnelly JP, Jackson G. Guidelines on the management of invasive fungal infection during therapy for haematological malignancy. British Committee for Standards in Haematology 2010 [monografia na internet]. [acesso em 26 nov 2011]. Disponível em: http://www.bcshguidelines.com/documents/fungal_infection_bcsh_2008.pdf [ Links ]
20. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis [periódico na internet]. 2008 [acesso em 7 fev 2013];46:327-60. Disponível em: http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/idsa-aspergilloisrx-2008guidelines.pdf [ Links ]
21.Walsh TJ, Pappas P, Winston D, Lazarus H, Petersen F, Raffalli J, et al. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med [periódico na internet]. 2002 [acesso em 7 mar 2013];346(4):225-34. Disponível em: http://www.nejm.org/doi/pdf/10.1056/NEJM200201243460403 [ Links ]
22. Walsh TJ, Teppler H, Donowitz GR, Maertens JA, Baden LR, Dmoszynska A, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med [periódico na internet]. 2004 [acesso em 7 fev 2013];351:1391-402. Disponível em:http://www.nejm.org/doi/pdf/10.1056/NEJMoa040446 [ Links ]
23. Wang JL, Chang CH, Young-Xu Y, Chan KA. Systematic review and meta-analysis of the tolerability and hepatotoxicity of antifungals in empirical and definitive therapy for invasive fungal infection. Antimicrob Agents Chemother [periódico na internet]. 2010 [acesso em 7 fev 2013];54(6):2409-2419. Disponível em: http://aac.asm.org/content/54/6/2409.full.pdf+html [ Links ]
2. De Pauw B, Donnelly J. Editorial. Prophylaxis and aspergillosis: has the principle been proven? N Engl J Med. 2007; 356(4): 409-11. [ Links ]
3. Del Bono V, Mikulska M, Viscoli C. Invasive aspergillosis: diagnosis, prophylaxis and treatment. Curr Opin Hematol. 2008; 15:586–93 [ Links ]
4. Díaz Pedroche C, Cisneros JM, Lumbreras C, Aguado JM, Grupo Clinico Espanol de Estudio de Voriconazol. Treatment of invasive fungal infections with voriconazole. Evaluation of experience with compassionate use of voriconazole in Spain. Rev Esp Quimioter [periódico na internet]. 2005 [acesso em 7 mar 2013];18(2):149-58. Disponível em http://www.seq.es/seq/0214-3429/18/2/149.pdf [ Links ]
5. Dominguez-Gil A, Martin I, Garcia Vargas M, Del Castillo A, Diaz S, Sanchez C. Economic evaluation of voriconazole versus caspofungin for the treatment of invasive aspergillosis in Spain. Clin Drug Invest. 2007; 27(3):197-205. [ Links ]
6. Freemantle N, Tharmanathan P, Herbrecht R. Systematic review and mixed treatment comparison of randomized evidence for empirical, pre-emptive and directed treatment strategies for invasive mould disease. J Antimicrob Chemother [periódico na internet]. 2011 [acesso em 7 fev 2013];66(Suppl1):i25–35. Disponível em: http://jac.oxfordjournals.org/content/66/suppl_1/i25.full.pdf+html [ Links ]
7. Garbino J, Schnetzler G, Roberts C. Invasive aspergillosis: is treatment with ‘inexpensive’ amphotericin B cost-saving if ‘expensive’ voriconazole is only used on demand. Swiss Med Wkly [periódico na internet]. 2006 [acesso em 7 fev 2013]; 136(39-40):624-630. Disponível em: http://www.smw.ch/docs/pdf200x/2006/39/smw-11259.pdf [ Links ]
8. Herbrecht R, Denning DW, Patterson TF, Bennett, J. E., Greene, R. E., Oestmann, J. W.et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med [periódico na internet]. 2002 [acesso em 7 fev 2013];347:408-15. Disponível em: http://www.nejm.org/doi/pdf/10.1056/NEJMoa020191 [ Links ]
9. Herbrecht R, Maertens J, Baila L, Aoun M, Heinz W, Martino R, et al. Caspofungin first-line therapy for invasive aspergillosis in allogeneic hematopoietic stem cell transplant patients: an European Organisation for Research and Treatment of Cancer study. Bone Marrow Transpl [periódico na internet]. 2010 [acesso em 7 fev 2013];45:1227-33. Disponível em: http://www.nature.com/bmt/journal/v45/n7/pdf/bmt2009334a.pdf [ Links ]
10. Jørgensen KJ, Gøtzsche PC, Johansen HK. Voriconazole versus amphotericin B in cancer patients with neutropenia. Cochrane Database of Systematic Reviews [base de dados na internet];10, Art. No. CD004707. DOI: 10.1002/14651858.CD004707.pub1. Ano 2009. [acesso em 23 dez 2011]. Disponível em: http://cochrane.bvsalud.org/cochrane/show.php?db=reviews&mfn=2791&id=CD004707&lang=pt&dblang=&lib=COC&print=yes
11.Kim A, Nicolau DP , Kuti JL. Hospital costs and outcomes among intravenous antifungal therapies for patients with invasive aspergillosis in the United States. Mycoses. 2011; 54: e301–e312. [ Links ]
12. Kontoyiannis DP, Marr KA, Park BJ, Alexander BD, Anaissie EJ, Walsh TJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clin Infect Dis [periódico na internet]. 2010 [acesso em 7 fev 2013];50:1091-100. Disponível em: http://cid.oxfordjournals.org/content/50/8/1091.full.pdf+html [ Links ]
13. Lortholary O, Gangneux JP, Sitbon K, Lebeau B, Monbrison F, Le Strat Y, et al. . Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005-2007). Clin Microbiol Infect [periódico na internet]. 2011 [acesso em 7 fev 2013]; 17(12):1882-1889. Disponível em: http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03548.x/pdf [ Links ]
14. Miceli MH, Lee SA. Emerging moulds: epidemiological trends and antifungal resistance. Mycoses. 2011. 54, e666–e678. [ Links ]
15. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica e Insumos Estratégicos. Formulário terapêutico nacional 2010: Rename 2010 [monografia na internet]. 2. ed. Brasília (DF); 2010. 1135 p. (Série B. Textos básicos de saúde). [acesso em 12 dez 2011]. Disponível em: http://portal.saude.gov.br/portal/arquivos/pdf/FTN_2010.pdf.
16. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes metodológicas: elaboração de pareceres técnico-científicos [monografia na internet]. 3.ed.rev.atual. Brasília (DF); 2011. 62 p. (Série A. Normas e manuais técnicos). [acesso em 23 jun 2012]. Disponível em: http://200.214.130.94/rebrats/publicacoes/DiretrizesPTC.pdf
17. Neofytos D, Horn D, Anaissie E, Marr KA, Olyaei A. Epidemiology and outcome of invasive fungal infection in adult haematopoetic stem cell transplant recipients: analysis of multicentre Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis [periódico na internet]. 2009 [acesso em 7 fev 2013]; 48:265-73. Disponível em: http://cid.oxfordjournals.org/content/48/3/265.full.pdf+html [ Links ]
18. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica [periódico na internet]. 2006 [acesso em 7 fev 2013];91:1068-75. Disponível em:http://www.haematologica-thj.org/content/91/8/1068.full.pdf [ Links ]
19. Prentice AG, Glasmacher A, Hobson RP, Schey S, Barnes RA, Donnelly JP, Jackson G. Guidelines on the management of invasive fungal infection during therapy for haematological malignancy. British Committee for Standards in Haematology 2010 [monografia na internet]. [acesso em 26 nov 2011]. Disponível em: http://www.bcshguidelines.com/documents/fungal_infection_bcsh_2008.pdf [ Links ]
20. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis [periódico na internet]. 2008 [acesso em 7 fev 2013];46:327-60. Disponível em: http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/idsa-aspergilloisrx-2008guidelines.pdf [ Links ]
21.Walsh TJ, Pappas P, Winston D, Lazarus H, Petersen F, Raffalli J, et al. Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med [periódico na internet]. 2002 [acesso em 7 mar 2013];346(4):225-34. Disponível em: http://www.nejm.org/doi/pdf/10.1056/NEJM200201243460403 [ Links ]
22. Walsh TJ, Teppler H, Donowitz GR, Maertens JA, Baden LR, Dmoszynska A, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med [periódico na internet]. 2004 [acesso em 7 fev 2013];351:1391-402. Disponível em:http://www.nejm.org/doi/pdf/10.1056/NEJMoa040446 [ Links ]
23. Wang JL, Chang CH, Young-Xu Y, Chan KA. Systematic review and meta-analysis of the tolerability and hepatotoxicity of antifungals in empirical and definitive therapy for invasive fungal infection. Antimicrob Agents Chemother [periódico na internet]. 2010 [acesso em 7 fev 2013];54(6):2409-2419. Disponível em: http://aac.asm.org/content/54/6/2409.full.pdf+html [ Links ]
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2013 Silvana Andréa Molina Lima, José Ruben de A. Bonfim, Eneida Rached Campos, Andréia de Fátima Nascimento
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