Voriconazole and Caspofungin Combination Effective in Invasive Aspergillosis

SAN DIEGO, CA— At IDWeek 2012, study investigators reported that the combination of voriconazole and caspofungin was associated with an improved response compared to caspofungin alone as primary therapy of invasive aspergillosis in patients with hematologic malignancy.

Ray Hachem, MD, from the University of Texas Anderson Cancer Center, Houston, TX, and colleagues conducted a study to evaluate the efficacy and safety of caspofungin and voriconazole as well as its combination as primary and salvage therapy for patients with invasive aspergillosis. A total of 231 patients with hematologic malignancies were diagnosed with invasive aspergillosis (as proven or probable according to EORTC/MSG criteria) between January 2000 and January 2011. For primary antifungal therapy, 36 patients received caspofungin alone, 51 patients received voriconazole alone, and 42 patients received combination voriconazole and caspofungin.

Among the caspofungin and the combination therapy group, more patients had leukemia or graft-versus-host disease (GVHD) compared to those treated with voriconazole alone (P<0.01). Response in the primary therapy for the combination of voriconazole and caspofungin was comparable to voriconazole alone (61% vs. 49%, P=0.3), but was significantly better than caspofungin alone (27%, P=0.03).

Regarding salvage therapy, these three groups also had comparable clinical characteristics except leukemia, which was higher in the caspofungin and the voriconazole group compared to the combination regimen (P=0.015). Response to salvage therapy was comparable in all three groups (P=0.44) However, voriconazole was associated with significantly lower aspergillosis-related mortality than the caspofungin group (24% vs. 57%; P=0.02).

Dr. Hachem and colleagues concluded that an improved response was seen with combination of voriconazole and caspofungin vs. caspofungin alone in primary therapy for invasive aspergillosis. However, when used as salvage therapy, voriconazole was associated with lower aspergillosis-related mortality compared to caspofungin monotherapy.