RRC ID 46901
Author Yoshida K, Kurashima A, Kamei K, Oritsu M, Ando T, Yamamoto T, Niki Y.
Title Efficacy and safety of short- and long-term treatment of itraconazole on chronic necrotizing pulmonary aspergillosis in multicenter study.
Journal J Infect Chemother
Abstract In the respiratory field, chronic pulmonary aspergillosis, such as chronic necrotizing pulmonary aspergillosis (CNPA) or aspergilloma, is important. We examined the efficacy and safety of short- and long-term itraconazole (ITCZ) administration, involving a switch from injection to an oral preparation, in patients with CNPA. In all hospitals participating in this study, the protocol was approved by the ethics review board. This study started after UMIN registration (UMIN000001727). Subjects enrolled in this study were patients who were clinically or definitively diagnosed with CNPA in the respiratory field, according to the diagnostic criteria of the Japanese "Guidelines for management of deep-seated mycosis 2007," in 16 hospitals that participated in this study between May 2008 and March 2011. Treatment was started with ITCZ injection. Subsequently, the agent was switched to an oral preparation. Efficacy was evaluated with major items (clinical symptoms, fever, imaging findings) and minor items (nutritional status, inflammatory markers). Twenty-nine patients were enrolled; safety was evaluated in 24 and efficacy in 23. Of the 23 patients, 10 (43.5 %) responded. With respect to the administration period, the response rates in 8 patients treated for a short period and 15 treated for a long period were 25.0 % and 53.3 %, respectively. Trough blood concentration of ITCZ reached a level at which ITCZ may be effective for aspergillosis at 3 days after the start of ITCZ injection therapy. After changing to high-dose capsules, its level was also maintained. Adverse events such as liver dysfunction and heart failure were observed in 9 of the 24 patients. Furthermore, 6 patients died. However, there was no relationship between these events and ITCZ. Step-down therapy from ITCZ injection to oral administration may be a useful treatment option in CNPA patients requiring long-term treatment.
Volume 18(3)
Pages 378-85
Published 2012-6-1
DOI 10.1007/s10156-012-0414-7
PII S1341-321X(12)70309-4
PMID 22526387
MeSH Adult Aged Aged, 80 and over Antifungal Agents / administration & dosage* Antifungal Agents / adverse effects Antifungal Agents / pharmacokinetics Cohort Studies Female Humans Invasive Pulmonary Aspergillosis / drug therapy* Invasive Pulmonary Aspergillosis / metabolism Itraconazole / administration & dosage* Itraconazole / adverse effects Itraconazole / pharmacokinetics Male Middle Aged Treatment Outcome
IF 1.722
Times Cited 22
Pathogenic microorganisms NA