Voriconazole for invasive bone aspergillosis: a worldwide experience of 20 cases.

Abstract

UNLABELLED:

BACKGROUND; Bone aspergillosis remains a rare but potentially devastating fungal disease. Although voriconazole is effective for invasive pulmonary aspergillosis, evidence of its efficacy for aspergillosis located in bone is limited.

METHODS:

We report our experience with voriconazole in 4 cases of invasive bone aspergillosis. In addition, all cases of probable and definite bone aspergillosis from the Pfizer clinical database were reviewed and analyzed to determine the safety and efficacy of voriconazole treatment. Global response was evaluated at the end of therapy on the basis of a composite assessment of overall clinical, radiological, and mycological responses.

RESULTS:

Twenty patients are described, of whom 18 had definite bone involvement diagnosed (spondylodiskitis in 9, sternum/rib osteomyelitis in 6, and peripheral bone involvement in 5). Of 20 patients, 14 were immunocompromised. Oral or intravenous voriconazole was given as salvage therapy for 18 patients; 2 patients received voriconazole as first-line therapy. Median duration of voriconazole treatment was 83.5 days (range, 4-395 days). Global response at end of therapy was satisfactory in 11 (55%) of 20 patients, including complete responses in 4 patients and partial responses in 7 patients; there were no relapses of infection in the 4 patients with complete response to therapy with voriconazole. Treatment was generally well tolerated.

CONCLUSIONS:

Long-term voriconazole treatment is a new therapeutic option for invasive aspergillosis with bone involvement.

• Authors: Houria Mouas, Irja Lutsar, Bertrand Dupont, Olivier Fain, Raoul Herbrecht, Francois-Xavier Lescure, Olivier Lortholary, Voriconazole/Bone Invasive Aspergillosis Study Group
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 40 Issue 8 Pg. 1141-7 (Apr 15 2005) ISSN: 1537-6591 [Electronic] United States
• PMID: 15791514 (Publication Type: Case Reports, Clinical Trial, Journal Article)

Chemical References

• Antifungal Agents
• Pyrimidines
• Triazoles
• Voriconazole

Topics

• Adolescent
• Adult
• Aged
• Antifungal Agents (adverse effects, therapeutic use)
• Aspergillosis (drug therapy)
• Child, Preschool
• Humans
• Middle Aged
• Osteitis (drug therapy, microbiology)
• Osteomyelitis (drug therapy, microbiology)
• Pyrimidines (adverse effects, therapeutic use)
• Salvage Therapy
• Spondylitis (drug therapy, microbiology)
• Triazoles (adverse effects, therapeutic use)
• Voriconazole