Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis
Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis
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DOI：
10.1086/589857
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发表时间：
2008-08-01
影响因子：
11.8
通讯作者：
Spellberg, Brad
中科院分区：
文献类型：
--
作者：
Reed, Caitlin;Bryant, Richard;Spellberg, Brad
背景棘白菌素（例如。例如，在一个实施例中，卡泊芬净）对毛霉菌病无效。然而，在临床前数据的基础上，我们最近开始用多烯-卡泊芬净联合治疗鼻-眶-脑毛霉菌病（ROCM）。为了确定多烯-卡泊芬净治疗的影响，对国际疾病分类第九次修订版检索确定的ROCM病例进行了回顾性审查，以收集人口统计学特征、临床病史和结局的数据。预定义的主要终点是成功（即，出院后30 d，患者均存活且未接受临终关怀。在12年内确定了41例活检证实的ROCM患者;其中23例（56%）为西班牙裔，34例（83%）为糖尿病患者。与多烯单药治疗患者相比，多烯-卡泊芬净治疗患者（6例可评价患者）的成功率（100% vs. 45%; P = 0.02）和Kaplan-Meier生存时间（P = 0.02）上级。与接受其他多烯类药物治疗的患者相比，接受阿朴霉素B脂质复合物治疗的患者成功率较低（37% vs. 72%; P= 0.03），临床失败率较高（45% vs. 21%; P = 0.04）。然而，与单独接受阿朴霉素B脂质复合物的患者相比，阿朴霉素B脂质复合物联合卡泊芬净治疗的患者具有上级的成功率（100% vs. 20%; P = 0.009）和生存时间（P = 0.01）。与单药治疗相比，联合治疗的获益在脑受累患者中最为明显（成功率，100% vs. 25%; P = 0.01）。在多变量分析中，仅接受联合治疗与预后改善显著相关（比值比，10.9; 95%可信区间，1.3-无穷大; P = 0.02）。多烯-卡泊芬净联合治疗是ROCM患者多烯单药治疗的一种有前景的潜在替代方案。有必要对这些发现进行随机、前瞻性调查。
Background. It has been axiomatic that echinocandins ( e. g., caspofungin) are ineffective against mucormycosis. However, on the basis of preclinical data, we recently began treating rhino- orbital- cerebral mucormycosis ( ROCM) with combination polyene- caspofungin therapy.Methods. To determine the impact of polyene-caspofungin therapy, ROCM cases identified by an International Classification of Diseases, Ninth Revision search were retrospectively reviewed to gather data on demographic characteristics, clinical history, and outcomes. The predefined primary end point was success (i.e., the patients was alive and not in hospice care) at 30 days after hospital discharge.Results. Forty-one patients with biopsy-proven ROCM were identified over 12 years; 23 (56%) of these patients were Hispanic, and 34 (83%) were diabetic. Patients treated with polyene-caspofungin therapy (6 evaluable patients) had superior success (100% vs. 45%; P = .02) and Kaplan-Meier survival time (P = .02), compared with patients treated with polyene monotherapy. Patients treated with amphotericin B lipid complex had inferior success (37% vs. 72%; P= .03) and a higher clinical failure rate (45% vs. 21%; P = .04), compared with patients who received other polyenes. However, patients treated with amphotericin B lipid complex plus caspofungin had superior success (100% vs. 20%; P = .009) and survival time (P = .01), compared with patients who received amphotericin B lipid complex alone. The benefit of combination therapy, compared with monotherapy, was most pronounced in patients with cerebral involvement (success rate, 100% vs. 25%; P = .01). In multivariate analysis, only receipt of combination therapy was significantly associated with improved outcomes (odds ratio, 10.9; 95% confidence interval, 1.3-infinity; P = .02).Conclusions. Combination polyene-caspofungin therapy represents a promising potential alternative to polyene monotherapy for patients with ROCM. Randomized, prospective investigation of these findings is warranted.