Treatment of invasive fungal disease using anidulafungin alone or in combination for hematologic patients with concomitant hepatic or renal impairment

Autores de IIS La Fe

• Pau Montesinos Fernández

  Autor

• Rebeca Rodríguez Veiga

  Autor

• David Martínez Cuadrón

  Autor

• Blanca Boluda Pascual

  Autor

• Belen Maria Vera Garcia

  Autor

• Carmen Maria Alonso Prieto

  Autor

• Jaime Sanz Caballer

  Autor

• Francisca Lopez Chulia

  Autor

• Guillermo Martin Aragones

  Autor

• Rosa Jannone Fores

  Autor

• Guillermo Sanz Santillana

  Autor

• Alma Lancharro

  Autor

• Isabel Cano Ferri

  Autor

• Vicente Javier Palau Perez

  Autor

• Jose Ignacio Lorenzo Herrero

  Autor

• Isidro Jarque Ramos

  Autor

• Miguel Salavert Lletí

  Autor

• Paula Ramírez Galleymore

  Autor

• Miguel Ángel Sanz Alonso

  Autor

Participantes ajenos a IIS La Fe

• Navarro I

Grupos

• Hematología y Hemoterapia

• Infección Grave

• Medicina Intensiva

Abstract

Background: Invasive fungal disease (IFD) treatment is challenging in hematologic patients due to drug interactions and toxicities that limit the use of the antifungal agents. Aims: To analyze retrospectively in terms of safety and potential efficacy anidulafungin therapy, alone or in combination. Methods: Our institutional guidelines recommended anidulafungin treatment in hematologic patients with suspected IFD and concomitant renal or liver impairment (to avoid drug interactions and preserve organ function). Results: From 2008 to 2013,24 episodes of IFD occurring in 21 patients were classified as proven (4 cases), probable (15 cases) and possible (5 cases). Anidulafungin was administered alone (13%) or in combination (88%). Eight (33%) episodes were resolved, using monotherapy (1 out of 3, 33%) or a combined therapy (7 out of 21,33%). Twelve cases (50%) were registered as failure (death due to IFD progression in 4 patients, and treatment change due to lack of efficacy in 8), and 4 cases (17%) were not evaluable (death unrelated to the IFD). Anidulafungin was not withdrawn in any case due to toxicity. Conclusions: Anidulafungin therapy, alone or in combination, could be considered in hematologic patients with IFD and concomitant liver or renal impairment. Due to the low number of patients, we cannot draw any conclusion about efficacy. (C) 2014 Revista Iberoamericana de Micologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Anidulafungin; Hematologic malignancies; High-risk; Invasive fungal disease