J. Petrovica, A. Ngaib, S. Bradshawb, A. Williams-Diazb, A. Taylorb, C. Sableb, S. Vuocolob, N. Kartsonisb

  目前，关于抗真菌药棘白菌素类（echinocandins）在实体器官移植（SOT）受体中的疗效和安全性的数据是有限的。我们回顾了3项临床试验的数据，其中SOT受体因侵袭性真菌感染（IFI）而使用卡泊芬净（caspofungin）治疗。患者使用caspofungin的剂量从50 毫克/天至100毫克/天不等。截至caspofungin疗法（EOT）结束时，我们发现caspofungin对所有患者均有效。我们还收集了所有患者的不良事件（AE）和实验数据，确定了22名SOT患者（年龄在34至67岁之间）的数据，这些患者均接受了至少一剂量的caspofungin治疗，其中6名患者感染了念珠菌血症（IC），16名患者可能感染了侵袭性曲霉病（IA）。所有感染IC的患者都把caspofungin疗法作为首选的治疗方案。caspofungin通过EOT成功治疗IC的比例为83%（5/6）。SOT类型的成功案例为：肾脏4例（共进行了5例），肝脏1例（共进行了1例）。所有感染IA（均为肺部感染）的16名患者都接受了caspofungin挽救疗法的治疗。Caspofungin通过EOT成功治疗IA的比例为50%（8/16）。SOT类型的成功案例为：心脏2例（共进行2例），心/肺0例（共进行2例），肾脏3例（共进行3例），肝脏1例（共进行3例），肺2例（总共进行了6例）。治疗的疗效并不受caspofungin用药剂量的影响。用药2至162天（平均36.8天）具有良好的耐受性，用药期间没有一例患者出现严重的药物不良反应，也没有患者因为药毒性而停止使用caspofungin。在这些有限的数据的基础上，caspofungin似乎对治疗SOT受体感染IC和IA具有一定的疗效，同时也有良好的耐受性。

Efficacy and Safety of Caspofungin in Solid Organ Transplant Recipients
J. Petrovica, A. Ngaib, S. Bradshawb, A. Williams-Diazb, A. Taylorb, C. Sableb, S. Vuocolob, N. Kartsonisb

Efficacy and safety data for the echinocandins in solid organ transplant (SOT) recipients are limited. We reviewed data from three clinical trials that enrolled SOT patients receiving caspofungin therapy for an invasive fungal infection (IFI). Caspofungin was administered at doses ranging from 50 to 100 mg/day. Efficacy was assessed in all patients at the end of caspofungin therapy (EOT). Adverse events (AE) and laboratory data were collected from all patients. We identified data from 22 SOT patients (aged 34–67 years) with proven invasive candidiasis (IC; 6 patients) or proven or probable invasive aspergillosis (IA; 16 patients) who received at least one dose of caspofungin therapy. All patients with IC received caspofungin as primary therapy. Caspofungin success against IC at EOT was 83% (5 of 6), with responses seen across Candida spp. Success by SOT type was: kidney 4 of 5 and liver 1 of 1. All 16 patients with IA (all pulmonary) received caspofungin as salvage therapy. Caspofungin success against IA at EOT was 50% (8 of 16), with responses seen for both definite (3 of 4) and probable IA (5 of 12). Success by SOT type was: heart 2 of 2, heart/lung 0 of 2, kidney 3 of 3, liver 1 of 3, and lung 2 of 6. The outcome was not influenced by caspofungin dose. Caspofungin, dosed for 2 to 162 (mean 36.8) days, was well tolerated. No patient had a serious drug-related adverse event or discontinued caspofungin due to toxicity. Based on these limited data, caspofungin appears to be an effective and well-tolerated option for the treatment of IC and IA in SOT recipients.

Volume 39, Issue 10, Pages 3117-3120 (December 2007)

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