What have we learned about systemic antifungals currently available on the market?
|
|
- Barbra Powell
- 6 years ago
- Views:
Transcription
1 2nd ECMM/CEMM Workshop Milano, September 25, 2010 What have we learned about systemic antifungals currently available on the market? Prof. Dr. Georg Maschmeyer Dept. of Hematology, Oncology & Palliative Care Klinikum Ernst von Bergmann Potsdam, Germany
2 Transparency Declaration Speaker fees: MSD, Pfizer, Gilead, Cephalon; Consultant: MSD, Pfizer, Gilead; Travel grants: Pfizer, MSD
3 Newer and Classical Antifungal Agents Amphotericin B Deoxycholate IV Liposomal Amphotericin B (AmBisome) IV AmB Lipid Complex (Abelcet) IV AmB Colloidal Dispersion (Amphocil/Amphotec) IV Fluconazole (Diflucan) IV/PO Voriconazole (Vfend) IV/PO Itraconazole (Sporanox/Sempera) IV/PO Posaconazole (Noxafil) PO Caspofungin (Cancidas) IV Micafungin (Mycamine) IV Isavuconazole/BAL4815/8557 IV/PO Anidulafungin (Ecalta/Eraxis) IV Ravuconazole 5-Flucytosine (Ancotil) IV/PO Albaconazole Terbinafine (Lamisil) PO Aminocandin IV Enfumafungin PO Anti-hsp90/Mycograb/Efungumab IV
4 Fluconazole Prophylaxis Prevents Candidiasis and Improves Survival After HSCT 1.00 Related and Unrelated Donor Transplant Survival Probability Fluconazole Placebo p = Years After Transplant Slavin MA et al, J Infect Dis 1995;171: Marr KA et al, Blood 2000;96:
5 Fungal Infections at Autopsy Post AlloBMT n = 355 autopsies at FHCRC Invasive Fungus Aspergillus/Mucor Candida - Hepatosplenic Fluconazole 37% 29% 8% 3% No Fluconazole 43% 18% 27% 16% 1987 incidence of IA 6% % Van Burik JA et al (Seattle), Medicine 1998;77:246-54
6 Fluconazole vs Itraconazole post-allosct n = 304 Discontinuation of itraconazole: 36% Itraconazole appears to prevent IMI in the subset of patients who tolerate the drug Marr KA et al (FHCRC Seattle), Blood 2004;103:
7 Flu- vs Itraconazole in Neutropenic Patients Glasmacher A et al, J Antimicrob Chemother 2006;57:317-25
8 Posaconazole vs Flu- or Itraconazole in Patients with AML or MDS NNT = 16 Cornely OA et al, N Engl J Med 2007;356:348-59
9 Micafungin vs Fluconazole post SCT: Treatment Success 1 0,9 p = Proportion of Patients with Treatment Success 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 Problems: 46% autologous SCT Too short Empir AF = failure Micafungin (N=425) Fluconazole (N=457) Days to Treatment Failure Van Burik JA et al, Clin Infect Dis 2004;39:
10 Posaconazole Prophylaxis in AlloSCT Recipients With GvHD Incidence of Proven or Probable IFI 30 Posaconazole Fluconazole p =.074 Number of IFIs p = p = p = All IFIs Invasive Aspergillosis All IFIs Invasive Aspergillosis While on treatment Primary time period 112 days after randomization Ullmann AJ et al, N Engl J Med 2007;356:335-47
11 Posa vs Flu / Vori vs Flu Prophylaxis in AlloSCT Patients Posaconazole trial* Characteristics Study Period (120 days) Total Aspergillus spp. POS n (%) 16 (5) 7 (2) FLU n (%) 27 (9) 21 (7) Proven/Prob. IFIs OR (95% CI) 0.56 ( ) 0.31 ( ) N = 600 total patients (301 POS group, 299 FLU group). *N Eng J Med 2007;356: BMT CTN trial** Characteristics VORI n (%) FLU n (%) Proven/Prob. IFIs OR (95% CI) Study Period (180 days) Total Aspergillus spp. 13 (4.2) 7 (2.2) 23 (7.8) 16 (5.4) N = 600 total patients (305 VORI group, 295 FLU group). ** Wingard J et al, Blood 2010 P Value P Value
12 New mechanism of resistance: Cyp51A amino acid substitution at codon 98 (L98H) together with a tandem repeat in the gene promoter Genotyping: no evidence for clonal spread of a single A. fumigatus genotype Verweij PE et al, N Engl J Med 2007;356:1481-3
13 Time to First Negative Blood Culture Percent of Patients Caspofungin (n=92) Amphotericin B (n=94) Caspofungin Amphotericin B Day % 19.1% Day % 9.0% Day 9 6.5% 6.4% Study Day Mora-Duarte J et al, N Engl J Med 2002;347:2020 9
14 Micafungin vs Liposomal Amphotericin B for Invasive Candidiasis Phase III, double-blind; 100 mg/d vs 3 mg/kg/d Success at end of therapy in the per-protocol treated patients Micafungin n = 202 AmBisome n = 190 Success 181 (89.6%) 170 (89.5%) C.albicans C.tropicalis C.glabrata 88.4% 92.3% 82.6% 89.3% 95.3% 80.0% MITT response rates: 74.1 vs 69.6% Significantly less infusion-related AE and nephrotox in mica arm Kuse ER et al, Lancet 2007;369:
15 Anidulafungin vs Fluconazole for Invasive Candidiasis and Candidemia Double-blind, phase III: 200/100 mg A vs 800/400 mg F (n = 256) C.krusei excluded Transition to oral fluconazole allowed (26 vs 29%) Success at end of IV therapy: 76 vs 60% (p = 0.01) In C.albicans: 81.1 vs 62.3% C.glabrata (16/22 pts.): 56.3 vs 50.0% C.parapsilosis (11/12): 63.6 vs 83.3% Reboli A et al, N Engl J Med 2007;356:
16 Micafungin vs Caspofungin for Invasive Candidiasis Response Rate Micafungin 100 mg Micafungin 150 mg Caspofungin 70/50 n = 200 n = 202 n = 193 Total 73.9% 70.3% 71.4% In subgroups Candida albicans 76.3% 69.6% 73.8% Candida non-albicans 75.2% 70.9% 71.1% Pappas PG et al, Clin Infect Dis 2007;45:883-93
17 Voriconazole vs AmB => Fluconazole in Non-Neutropenic Patients with Candidemia n = 248 vs 122 Response EoT: 65 vs 71% Median time to neg. BC: 2 days in both groups Survival day 98: 63 vs 58% More nephrotoxicity in AmB/FLU recipients Kullberg BJ et al, Lancet 2005;366:
18 ECIL Guidelines 2007 First-Line Antifungal Therapy in Candidemia Before Species Identification Herbrecht R et al, Eur J Cancer Suppl 2007;5:49-59
19 ECIL Guidelines 2009 First-Line Antifungal Therapy of IPA
20 Randomized Comparison of Voriconazole vs AmB for Primary Therapy of Invasive Aspergillosis Herbrecht R et al (EORTC IFICG), N Engl J Med 2002;347:408-15
21 Improved Response with Pre-Emptive Treatment Based on Halo Sign (p < 0.01) 3 mo survival = 71% vs 53% (p < 0.01) Greene RE et al, Clin Infect Dis 2007; 44:373-9
22 L-AmB (3 vs 10 mg/kg/d) in Immunocompromised Patients with Invasive Filamentous FI Response at EoT [MITT] N (%) Favorable Overall Response at EoT CR PR L-AmB 3mg n= (50) 1 (1) 52 (49) L-AmB 10mg n=94 43 (46) p = (2) 41 (44) Cornely OA et al (AmBiLoad Study), Clin Infect Dis 2007;44:
23 L-AmB (3 mg/kg/d) in Immunocompromised Patients with Invasive Filamentous FI: Survival in Patients with Possible vs Proven/Probable IPA Cornely OA et al (AmBiLoad Study), Mycoses 2010 (in press)
24 Voriconazole in 86 Patients with Cerebral Aspergillosis: Retrospective Analysis Age 9 mo - 81 y., proven or probable CNS aspergillosis Biopsy-proven: A.fumigatus 34 pts. A.nidulans 5 pts. Aspergillus spp 24 pts. Underlying condition BMT Hematological malignancy Organ TxP n Median Rx days (range) 20 (3 390) 96 (5 522) 39 (7 825) Efficacy % Chronic imm. suppression (9 1128) 45 Other (1 946) 50 Total (1 1128) 35 Schwartz S et al, Blood 2005;106:2641-5
25 Caspofungin Salvage for IA: Expert Panel Assessment of Outcome Favorable Response Efficacy Analysis n/n (%) Primary: All patients with diagnosis who receive at least 1 dose of caspofungin 37/83 (44.6) Secondary: Patients who received >7 days of caspofungin 37/66 (56.1) Maertens J et al, Clin Infect Dis 2004;39:
26 Posaconazole in Patients with IA Refractory to or Intolerant of Conventional AF Therapy n = 107, vs historical control (n = 86) from same institutions (Lor D-AmB, itra, investigational AF) 74% hematological malignancy, 51% SCT Success at End of Treatment: 42 vs 26% (p = 0.006) CR 7 vs 9%, PR 36 vs 16% Walsh TJ et al, Clin Infect Dis 2007;44:2-12
27 Treatment of Mucormycoses Pulmonary Liposomal AmB (A-II); dosage 5mg/kg (B-III) ABLC (A-III) Posaconazole (A-III) Posaconazole as maintenance therapy in patients with a partial response (C-III) CNS or sinus involvement plus surgical intervention, if feasible (B-III) Böhme A et al (AGIHO), Ann Hematol 2009;88:97-110
28 Greenberg RN et al, Antimicrob Agents Chemother 2006;50:126-33
29 Posaconazole for Salvage Treatment in 91 Patients with Mucormycoses 60% CR/PR, 21% SD CR/PR in Leukemia/Lymphoma (48) 58.3% Steroid treatment (31) 51.6% Diabetes mellitus (30) 60.0% GvHD (30) 60.0% Neutropenia < 500 (29) 62.1% SCT (27) 51.9% Serum albumin < 3 (22) 45.5% SOTxP (10) 60.0% Van Burik JA et al, Clin Infect Dis 2006;42:e61-5
30 Synopsis: Use of Newer Antifungals Caspofungin First-line therapy of invasive candidiasis Second-line therapy of invasive aspergillosis Micafungin First-line therapy of invasive candidiasis Anidulafungin First-line therapy of invasive candidiasis Voriconazole First-line therapy of invasive aspergillosis Second-line therapy of invasive aspergillosis after L-AmB First- or second-line therapy of invasive candidiasis in selected patients (simultaneous Aspergillus coverage; oral maintenance in fluconazole-resistant cases) Posaconazole Second-line therapy of invasive aspergillosis Oral treatment of mucormycoses
Prophylaxis, Empirical, Pre-emptive Therapy of Aspergillosis in Hematological Patients: Which Strategy?
TIMM-4 18-21 October 2009 Athens, Greece Prophylaxis, Empirical, Pre-emptive Therapy of Aspergillosis in Hematological Patients: Which Strategy? www.ichs.org Georg Maschmeyer Dept. of Hematology, Oncology
More informationNew Directions in Invasive Fungal Disease: Therapeutic Considerations
New Directions in Invasive Fungal Disease: Therapeutic Considerations Coleman Rotstein, MD, FRCPC, FACP University of Toronto University Health Network Toronto, Ontario Disclosure Statement for Coleman
More informationNo Evidence As Yet. Georg Maschmeyer. Dept. of Hematology, Oncology & Palliative Care Klinikum Ernst von Bergmann Potsdam, Germany
Is Combined Antifungal Therapy More Efficient than Single Agent Therapy? No Evidence As Yet www.ichs.org Georg Maschmeyer Dept. of Hematology, Oncology & Palliative Care Klinikum Ernst von Bergmann Potsdam,
More informationAntifungals in Invasive Fungal Infections: Antifungals in neutropenic patients
BVIKM-SBIMC La Hulpe, 6 November 2008 Antifungals in Invasive Fungal Infections: Antifungals in neutropenic patients Johan Maertens, MD Acute Leukemia and SCT Unit University Hospital Gasthuisberg Catholic
More informationOliver A. Cornely. Department I for Internal Medicine Haematology / Oncology / Infectious Diseases / Intensive Care 2. Centre for Clinical Research
Management of Confirmed Aspergillosis Oliver A. Cornely 1 Department I for Internal Medicine Haematology / Oncology / Infectious Diseases / Intensive Care 2 Centre for Clinical Research University of Cologne
More informationADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS
ADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS COMMERCIAL RELATIONS DISCLOSURE 2500 9000 15000 Astellas Gilead Sciences Pfizer Inc Expert advice Speaker s bureau Speaker s bureau OUTLINE OF THE PRESENTATION
More informationAntifungal Therapy in Leukemia Patients
Antifungal Therapy in Leukemia Patients UPDATE ECIL 4, 6 September 2011 Raoul Herbrecht, Ursula Flückiger, Bertrand Gachot, Patricia Ribaud, Anne Thiebaut, Catherine Cordonnier UPDATE ECIL 4, 2011 UPDATE
More informationCurrent options of antifungal therapy in invasive candidiasis
Current options of antifungal therapy in invasive candidiasis Saloua Ladeb Bone Marrow Transplant Center Tunis HAMMAMET 24 th April 2012 DEFINITION One or more positive results on blood culture for Candida
More informationTherapy of Hematologic Malignancies Period at high risk of IFI
Therapy of Hematologic Malignancies Period at high risk of IFI Neutrophils (/mm 3 ) 5 Chemotherapy Conditioning Regimen HSCT Engraftment GVHD + Immunosuppressive Treatment Cutaneous and mucositis : - Direct
More informationFungal Infection in the ICU: Current Controversies
Fungal Infection in the ICU: Current Controversies Andrew F. Shorr, MD, MPH, FCCP, FACP Washington Hospital Center Georgetown University, Washington, DC Disclosures I have served as a consultant to, researcher/investigator
More informationTreatment and Prophylaxis
Treatment and Prophylaxis Andreas H. Groll, M.D. Infectious Disease Research Program Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology University Children s Hospital
More informationTOWARDS PRE-EMPTIVE? TRADITIONAL DIAGNOSIS. GALACTOMANNAN Sensitivity 61% Specificity 93% Neg Predict Value >95% β-d-glucan Neg Predict Value 100% PCR
TOWARDS PRE-EMPTIVE? GALACTOMANNAN Sensitivity 61% Specificity 93% Neg Predict Value >95% TRADITIONAL DIAGNOSIS β-d-glucan Neg Predict Value 100% PCR diagnostics FUNGAL BURDEN FIRST TEST POSITIVE FOR ASPERGILLOSIS
More informationOptimal Management of Invasive Aspergillosis in the Context of New Guidelines in High Risk Haematological Patients
Optimal Management of Invasive Aspergillosis in the Context of New Guidelines in High Risk Haematological Patients Shariq Haider Professor Medicine McMaster University Conflict of Interest Disclosure Slide
More informationMANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS
MANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS Paul D. Holtom, MD Associate Professor of Medicine and Orthopaedics USC Keck School of Medicine Numbers of Cases of Sepsis in the United States, According
More informationGeorg Maschmeyer. Dept. of Hematology, Oncology & Palliative Care Klinikum Ernst von Bergmann Potsdam, Germany.
www.ichs.org Georg Maschmeyer Dept. of Hematology, Oncology & Palliative Care Klinikum Ernst von Bergmann Potsdam, Germany gmaschmeyer@klinikumevb.de www.dghoinfektionen.de 519 A. fumigatus isolates: Itraconazole
More informationTreatment Guidelines for Invasive Aspergillosis
Treatment Guidelines for Invasive Aspergillosis Thomas F. Patterson, MD Professor of Medicine Director, San Antonio Center for Medical Mycology The University of Texas Health Science Center at San Antonio
More informationMicafungin, a new Echinocandin: Pediatric Development
Micafungin, a new Echinocandin: Pediatric Development Andreas H. Groll, M.D. Infectious Disease Research Program Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology University
More informationNEW ANTI-INFECTIVE AGENTS IN 2003 : SPECTRUM AND INDICATIONS. 20th Symposium (spring 2003) Thursday May 22nd 2003
NEW ANTI-INFECTIVE AGENTS IN 2003 : SPECTRUM AND INDICATINS 20th Symposium (spring 2003) Thursday May 22nd 2003 The slides presented at this meeting are available on this site as "Web slide shows" and
More informationPrimary prophylaxis of invasive fungal infection in patients with haematological diseases
Primary prophylaxis of invasive fungal infection in patients with haematological diseases Tunis, May 24 2012 Important questions for antifungal prophylaxis Who are the patients at risk? Which is the risk:
More informationESCMID Online Lecture Library. by author
How To Best Use Antifungal Agents Cornelia Lass-Flörl Division of Hygiene and Medical Microbiology Innsbruck Medical University ESCMID SUMMER SCHOOL 2012 Epidemiology Diagnosis Roadmap Antifungal drugs
More informationESCMID Online Lecture Library. by author
The antibacterial experience: indications for clinical use of antimicrobial combinations To prevent the emergence of resistant organisms (tuberculosis) To treat polymicrobial infections (abdominal complicated
More informationHow Can We Prevent Invasive Fungal Disease?
How Can We Prevent Invasive Fungal Disease? Chris Kibbler Professor of Medical Microbiology University College London And Royal Free Hospital, London, UK Invasive Aspergillosis 2 - Acquisition Preventive
More informationForm 2046 R3.0: Fungal Infection Pre-HSCT Date
Key Fields Sequence Number: Date Received: - - CIBMTR Center Number: CIBMTR Recipient ID: Today's Date: - - Date of HSCT for which this form is being completed: - - HSCT type: (check all that apply) Autologous
More informationItraconazole vs. fluconazole for antifungal prophylaxis in allogeneic stem-cell transplant patients D. J. Winston
REVIEW Itraconazole vs. fluconazole for antifungal prophylaxis in allogeneic stem-cell transplant patients D. J. Winston Division of Hematology-Oncology, Department of Medicine, UCLA Medical Center, Los
More informationTreatment Guidelines for Invasive Aspergillosis
Treatment Guidelines for Invasive Aspergillosis Thomas F. Patterson, MD Professor of Medicine Director, San Antonio Center for Medical Mycology The University of Texas Health Science Center at San Antonio
More informationWhen is failure failure?
When is failure failure? Bart-Jan Kullberg, M.D. Radboud University Nijmegen The Netherlands The ICU patient with candidemia!! Female, 39 years old!! Multiple abdominal surgeries for Crohn's disease!!
More informationAntifungal Update. Candida: In Vitro Antifungal Susceptibility Testing
Antifungal Update B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy School of Pharmacy University of California San Francisco The patient spikes a new fever and 3/3 blood
More informationPROGRESSI NELLA TERAPIA ANTIFUNGINA. A tribute to Piero Martino
PROGRESSI NELLA TERAPIA ANTIFUNGINA A tribute to Piero Martino 1946-2007 ITALIAN ICONS IERI, OGGI, E DOMANI IERI, OGGI, E DOMANI IERI, OGGI, E DOMANI 1961 CAUSES OF DEATH IN PATIENTS WITH MALIGNANCIES
More informationAntifungal Update 2/22/12. Which is the most appropriate initial empirical therapy in a candidemic patient?
Antifungal Update B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy School of Pharmacy University of California San Francisco 3/3 blood cultures are positive for an unidentified
More informationProphylaxis versus Diagnostics-driven approaches to treatment of Invasive fungal diseases. Y.L. Kwong Department of Medicine University of Hong Kong
Prophylaxis versus Diagnostics-driven approaches to treatment of Invasive fungal diseases Y.L. Kwong Department of Medicine University of Hong Kong Pathogenic yeast Candida Cryptococcus Trichosporon Pathogenic
More informationHOW TO DEFINE RESPONSE IN ANTIFUNGAL CLINICAL TRIALS?
HOW TO DEFINE RESPONSE IN ANTIFUNGAL CLINICAL TRIALS? EORTC IFICG START Look for Help? MORTALITYASSOCIATED WITH INVASIVE ASPERGILLOSIS Lin et al. Clin Infect Dis 2001;32:358 100 % 50 n = 178 0 0 60 120
More informationAmphotericin B Lipid Complex (Abelcet ) 05/06
Amphotericin B Lipid Complex (Abelcet ) Structure and Activity AMB : DMPC : DMPG lipid complex, 10:7:3 mol:mol ribbon-like lipid structures, 1.6-11 µm in diameter binds to ergosterol disturbance of cell
More informationI am against to TDM in critically ill patient
TDM I am against to TDM in critically ill patient TDM of antifungals: where are we? Dr. Rafael Zaragoza Antifungal therapy in ICU; prophylaxis, pre-emptive and targeted Conflicts of interest: Pfizer Astellas
More informationUse of Antifungals in the Year 2008
Use of Antifungals in the Year 2008 Jose G. Montoya, MD Associate Professor of Medicine Associate Chief for Clinical Affairs Division of Infectious Diseases Stanford University School of Medicine Diagnosis
More informationAntifungals and current treatment guidelines in pediatrics and neonatology
Dragana Janic Antifungals and current treatment guidelines in pediatrics and neonatology Dragana Janic. University Children`s Hospital, Belgrade, Serbia 10/10/17 Hotel Crowne Plaza, Belgrade, Serbia; www.dtfd.org
More informationProphylaxis Limitations: Challenges in the Management of Invasive Aspergillosis
Prophylaxis Limitations: Challenges in the Management of Invasive Aspergillosis Pranatharthi H. Chandrasekar, MD Professor, Department of Medicine Wayne State University School of Medicine Karmanos Cancer
More informationSolid organ transplant patients
M.6 Meet-the-expert sessions Solid organ transplant patients Martin Iversen, Denmark José M. Aguado, Spain Copenhagen, Sunday 13 October 2013 Conflict of interest disclosure In the past 5 years, J.M.A.
More informationEmpirical Antifungal Therapy 2009 Update of ECIL-1 / ECIL-2 Guidelines O. Marchetti, C. Cordonnier, T. Calandra
UPDATE ECIL-3 2009 Empirical Antifungal Therapy 2009 Update of ECIL-1 / ECIL-2 Guidelines O. Marchetti, C. Cordonnier, T. Calandra 1 Background Empirical antifungal therapy for suspected invasive fungal
More informationAntifungal Update 2/24/11. Which is the most appropriate initial empirical therapy in a candidemic patient?
Antifungal Update B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy School of Pharmacy University of California San Francisco The patient spikes a new fever and 3/3 blood
More informationAntifungal Pharmacodynamics A Strategy to Optimize Efficacy
Antifungal Pharmacodynamics A Strategy to Optimize Efficacy David Andes, MD Associate Professor, Department of Medicine Division of Infectious Diseases Medical Microbiology and Immunology University of
More informationESCMID Online Lecture Library. by author. Salvage Therapy of Invasive Aspergillosis Refractory to Primary Treatment with Voriconazole
Salvage Therapy of Invasive Aspergillosis Refractory to Primary Treatment with Voriconazole J.A. Maertens, hematologist, MD, PhD University Hospital Gasthuisberg Leuven, Belgium Current guidelines: first-line
More informationManagement Strategies For Invasive Mycoses: An MD Anderson Perspective
Management Strategies For Invasive Mycoses: An MD Anderson Perspective Dimitrios P. Kontoyiannis, MD, ScD, FACP, FIDSA Professor of Medicine Director of Mycology Research Program M. D. Anderson Cancer
More informationTherapeutic Options: Where do we stand? Where do we go?
Therapeutic Options: Where do we stand? Where do we go? Oliver A. Cornely MD, FACP, FIDSA, FAAM Chair, Translational Research, CECAD Cluster of Excellence Deputy Head, Division of Infectious Diseases Director,
More informationCURRENT AND NEWER ANTI-FUNGAL THERAPIES- MECHANISMS, INDICATIONS, LIMITATIONS AND PROBLEMS. Dr AMIT RAODEO DM SEMINAR
CURRENT AND NEWER ANTI-FUNGAL THERAPIES- MECHANISMS, INDICATIONS, LIMITATIONS AND PROBLEMS Dr AMIT RAODEO DM SEMINAR Introduction The incidence of invasive fungal infections in critically ill intensive
More informationIsavuconazole. Lepak et al 2013 Antimicrob Agents Chemother 57: Lepak et al 2013 Antimicrob Agents Chemother 57:
Priv.-Doz. Dr. med. Maria J.G.T. Vehreschild Department I of Internal Medicine Clinical Trials Unit II Infectious Diseases Research Group Clinical Microbiome Isavuconazole 09.07.2017 Maria J.G.T. Vehreschild
More informationChallenges and controversies of Invasive fungal Infections
Challenges and controversies of Invasive fungal Infections Mona Al-Dabbagh, MD, MHSc Assistant Professor of Pediatrics, COM-KSAU-HS Consultant Pediatric Infectious Diseases and Transplant Infectious Diseases
More informationFungal Infection Pre-Infusion Data
Fungal Infection Pre-Infusion Data Registry Use Only Sequence Number: Date Received: CIBMTR Center Number: Event date: / / CIBMTR Form 2046 revision 5 (page 1 of 5). Last Updated May, 2018. Infection Episode
More informationUse of Antifungal Drugs in the Year 2006"
Use of Antifungal Drugs in the Year 2006" Jose G. Montoya, MD Associate Professor of Medicine Associate Chief for Clinical Affairs Division of Infectious Diseases Stanford University School of Medicine
More informationApplication of PK/PD concepts and the role of TDM in the management of patients with fungal disease. The role of combination therapy as of May 2011
Application of PK/PD concepts and the role of TDM in the management of patients with fungal disease The role of combination therapy as of May 2011 Claudio Viscoli, MD Professor of Infectious Disease Chief,
More informationTREATMENT STRATEGIES FOR INVASIVE FUNGAL INFECTIONS. Part I: EMPIRICAL THERAPY
TREATMENT STRATEGIES FOR INVASIVE FUNGAL INFECTIONS Part I: EMPIRICAL THERAPY CAUSES OF DEATH IN PATIENTS WITH MALIGNANCIES NIJMEGEN, THE NETHERLANDS n = 328 BACTERIAL INFECTION FUNGAL INFECTION 7% 36%
More informationClinical Considerations in the Management of Systemic Fungal Infections. Conducted during the 41 st ASHP Midyear Clinical Meeting Anaheim, California
Clinical Considerations in the Management of Systemic Fungal Infections Conducted during the 41 st ASHP Midyear Clinical Meeting Anaheim, California CONTINUING EDUCATION ACCREDITATION The American Society
More informationAntifungal prophylaxis: Whom, what and when
Antifungal prophylaxis: Whom, what and when Professor Yee-Chun Chen Professor of Medicine National Taiwan University Hospital and College of Medicine; Investigator, National Institute of Infectious Diseases
More informationFungal infections in ICU. Tang Swee Fong Department of Paediatrics Universiti Kebangsaan Malaysia
Fungal infections in ICU Tang Swee Fong Department of Paediatrics Universiti Kebangsaan Malaysia Epidemiology of invasive fungal infections - US +300% Martin GS, et al. N Engl J Med 2003;348:1546-1554
More informationConsiderations for Antifungal Management in Pediatric Cancer Patients
Considerations for Antifungal Management in Pediatric Cancer Patients Andreas H. Groll, M.D. Infectious Disease Research Program Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology
More informationMANAGEMENT OF PULMONARY MYCOSIS
MANAGEMENT OF PULMONARY MYCOSIS Eva Van Braeckel, MD, PhD Dpt. of Respiratory Medicine UZ Gent PENTALFA KU Leuven 03.03.2016 MANAGEMENT OF PULMONARY MYCOSIS 1. Antifungals 1. Acute invasive pulmonary aspergillosis
More informationCigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Voriconazole Effective Date... 3/15/2018 Next Review Date... 3/15/2019 Coverage Policy Number... 4004 Table of Contents Coverage Policy... 1 General Background...
More informationGuidelines for Antifungal Therapy for Invasive Fungal Infection. National Comprehensive Cancer Care Network
Guidelines for Antifungal Therapy for Invasive Fungal Infection Guidelines for Antifungal Therapy for Invasive Fungal Infection ew Antifungals Dr Rosemary Barnes Infectious Diseases Society of America
More informationEMA Pediatric Web Synopsis Protocol A November 2011 Final PFIZER INC.
PFIZER INC. These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert. For publications based on this study, see associated bibliography.
More informationEMERGING FUNGAL INFECTIONS IN IMMUNOCOMPROMISED PATIENTS
EMERGING FUNGAL INFECTIONS IN IMMUNOCOMPROMISED PATIENTS DR LOW CHIAN YONG MBBS, MRCP(UK), MMed(Int Med), FAMS Consultant, Dept of Infectious Diseases, SGH Introduction The incidence of invasive fungal
More informationImproving Clinical Outcomes in Fungal Infection Control and Management
Improving Clinical Outcomes in Fungal Infection Control and Management DISCLAIMER The information within this CME/CE activity is for continuing education purposes only, and is not intended to substitute
More informationAntifungal Pharmacotherapy
Interpreting Antifungal Susceptibility Testing: Science or Smoke and Mirrors A. W. F O T H E R G I L L, M A, M B A U N I V E R S I T Y O F T E X A S H E A L T H S C I E N C E C E N T E R S A N A N T O
More informationAntifungal therapy in children. Adilia Warris MD PhD FRCPCH Clinical Reader Pediatric Infectious Diseases Specialist
Antifungal therapy in children Adilia Warris MD PhD FRCPCH Clinical Reader Pediatric Infectious Diseases Specialist Invasive fungal infections in Pediatrics Children and adolescents are similarly vulnerable
More informationFungal Infection Post-Infusion Data
Fungal Infection Post-Infusion Data Registry Use Only Sequence Number: Date Received: CIBMTR Center Number: Event date: / / Visit: 100 day 6 months 1 year 2 years >2 years. Specify: CIBMTR Form 2146 revision
More informationCondition First line Alternative Comments Candidemia Nonneutropenic adults
Recommendations for the treatment of candidiasis. Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America. Condition First line Alternative
More informationADVANCES AND CHALLENGES IN HEMATOLOGY. Invasive fungal disease management in febrile neutropenia
16 th Annual Meeting of Saudi Society of Hematology 7 th Pan Arab Hematology Association Congress ADVANCES AND CHALLENGES IN HEMATOLOGY Invasive fungal disease management in febrile neutropenia J.A. Maertens,
More informationManagement Of Invasive Fungal Infections In Immunosupressed Hosts
Management Of Invasive Fungal Infections In Immunosupressed Hosts Dimitrios P. Kontoyiannis, MD, MS, DSc, FACP, FIDSA Professor of Medicine Director of Mycology Research Program Department of Infectious
More informationAntibiotics 301: Antifungal Agents
Antibiotics 301: Antifungal Agents B. Joseph Guglielmo, Pharm.D. Professor and Dean School of Pharmacy University of California San Francisco Disclosures No potential conflicts of interest. 1 3/3 blood
More informationAntifungal Agents - Cresemba (isavuconazonium), Vfend. Prior Authorization Program Summary
Antifungal Agents - Cresemba (isavuconazonium), Noxafil (posaconazole), Vfend (voriconazole) Prior Authorization Program Summary FDA APPROVED INDICATIONS DOSAGE 1,2,14 Drug FDA Indication(s) Dosing Cresemba
More informationBroad spectrum triazoles: which drug and when?
Broad spectrum triazoles: which drug and when? Martin Hoenigl, PD, MD, FECMM Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University Graz, Austria AND Division
More informationIntroduction. J Antimicrob Chemother 2011; 66 Suppl 1: i25 35 doi: /jac/dkq439. Nick Freemantle 1 *, Puvan Tharmanathan 2 and Raoul Herbrecht 3
J Antimicrob Chemother 2011; 66 Suppl 1: i25 35 doi:10.1093/jac/dkq439 Systematic review and mixed treatment comparison of randomized evidence for empirical, pre-emptive and directed treatment strategies
More informationDutch Working Party on Antibiotic Policy. SWAB Guidelines for the Management of Invasive Fungal Infections. September 2008
Dutch Working Party on Antibiotic Policy SWAB Guidelines for the Management of Invasive Fungal Infections September 2008 SWAB Invasive Fungal Infections Guidelines Committee Professor B.J. Kullberg (chair)
More informationLondon New Drugs Group APC/DTC Briefing
London New Drugs Group APC/DTC Briefing Posaconazole for invasive fungal infections Contents Background 2 Dosing Information 3 Clinical evidence for treatment of infections 3 Clinical evidence for prophyactic
More informationNationwide survey of treatment for pediatric patients with invasive fungal infections in Japan
J Infect Chemother (2013) 19:946 950 DOI 10.1007/s10156-013-0624-7 ORIGINAL ARTICLE Nationwide survey of treatment for pediatric patients with invasive fungal infections in Japan Masaaki Mori Received:
More informationTrends in Invasive Fungal Infection (IFI) in Haematology-Oncology Patients. Saturday, April 18, 2015 Charlottetown, P.E.I.
Trends in Invasive Fungal Infection (IFI) in Haematology-Oncology Patients Saturday, April 18, 2015 Charlottetown, P.E.I. Moderator & Speaker: Shariq Haider MD, FRCPC, FACP, CCST(UK), DTMH(UK) Professor
More informationEvaluation of hypokalemia and potassium supplementation during administration of liposomal amphotericin B
EXPERIMENTAL AND THERAPEUTIC MEDICINE 7: 941-946, 2014 Evaluation of hypokalemia and potassium supplementation during administration of liposomal amphotericin B EISEKI USAMI 1, MICHIO KIMURA 1, TETSUFUMI
More informationCombination Antifungal Therapy for Invasive Aspergillosis
MAJOR ARTICLE Combination Antifungal Therapy for Invasive Aspergillosis Kieren A. Marr, 1,2 Michael Boeckh, 1,2 Rachel A. Carter, 1 Hyung Woo Kim, 1 and Lawrence Corey 1,2 1 Fred Hutchinson Cancer Research
More informationHistorically, amphotericin B deoxycholate
OUR CURRENT UNDERSTANDING OF THERAPIES FOR INVASIVE FUNGAL INFECTIONS * John R. Perfect, MD ABSTRACT This article provides an update on the current state of the art for treating invasive fungal infections,
More informationOptimizing antifungal dosing regimens. Joseph Meletiadis, PhD, FECMM Assistant Professor of Microbiology
ATHENA 2017 International Conference November 28 30, 2017 Optimizing antifungal dosing regimens Joseph Meletiadis, PhD, FECMM Assistant Professor of Microbiology Clinical Microbiology Laboratory, «Attikon»
More informationNewer Combination Therapies
Newer Combination Therapies William J. Steinbach, MD Associate Professor of Pediatrics, Molecular Genetics & Microbiology Pediatric Infectious Diseases Duke University Medical Center Combination Therapy
More informationREVIEW. Liposomal amphotericin B: what is its role in 2008? F. Lanternier 1 and O. Lortholary 1,2
REVIEW Liposomal amphotericin B: what is its role in 2008? F. Lanternier 1 and O. Lortholary 1,2 1 Faculté de Médecine Paris Descartes, Service des Maladies Infectieuses et Tropicales, Centre d Infectiologie
More informationInvasive Fungal Infections in Solid Organ Transplant Recipients
Outlines Epidemiology Candidiasis Aspergillosis Invasive Fungal Infections in Solid Organ Transplant Recipients Hsin-Yun Sun, M.D. Division of Infectious Diseases Department of Internal Medicine National
More informationRezafungin: A Novel Echinocandin. Taylor Sandison, MD MPH Chief Medical Officer ISHAM- Amsterdam July 2, 2018
: A Novel Echinocandin Taylor Sandison, MD MPH Chief Medical Officer ISHAM- Amsterdam July 2, 2018 Disclosures Dr. Sandison is an employee of and stockholder in Cidara Therapeutics. Cidara Pipeline Program
More informationTRANSPARENCY COMMITTEE OPINION. 8 November 2006
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 8 November 2006 VFEND 50 mg, film-coated tablets B/28 (CIP: 3592886) B/56 (CIP: 3592892) VFEND 200 mg, film-coated
More informationEvidence-Based Approaches to the Safe and Effective Management of Invasive Fungal Infections. Presenter. Disclosures
Evidence-Based Approaches to the Safe and Effective Management of Invasive Fungal Infections Presenter James S. Lewis II, PharmD, FIDSA ID Clinical Pharmacy Coordinator Oregon Health and Science University
More informationamphotericin B empiric therapy; preemptive therapy presumptive therapy Preemptive therapy Presumptive therapy ET targeted therapy ET
4 17 9 27 17 1 7 amphotericin B 34 empiric therapy; ET preemptive therapy presumptive therapy Preemptive therapy Presumptive therapy ET targeted therapy ET Key words: antifungal therapyempiric therapypreemptive
More informationApproach to Fungal Infections
Approach to Fungal Infections Michelle A. Barron, M.D. Professor of Medicine Division of Infectious Diseases University of Colorado Denver Disclosures Research Investigation with Astellas Pharma, US I
More informationAntifungal Stewardship. Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul
Antifungal Stewardship Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul 1 2 Objectives What do we know? Invasive Candida and Aspergillosis Impact
More information9/7/2018. Faculty. Overcoming Challenges in the Management of Invasive Fungal Infections. Learning Objectives. Faculty Disclosure
Faculty Overcoming Challenges in the Management of Invasive Fungal James S. Lewis II, PharmD, FIDSA ID Clinical Pharmacy Coordinator Oregon Health and Science University Departments of Pharmacy and Infectious
More informationAntifungal Treatment in Neonates
Antifungal Treatment in Neonates Irja Lutsar University of Tartu, Estonia Lisbon, 12. October 2015 Prevalence of invasive fungal infections in NeoINN database 2005-2014 UK; 2012-2014 Estonia & Greece 1
More informationAn Update in the Management of Candidiasis
An Update in the Management of Candidiasis Daniel B. Chastain, Pharm.D., AAHIVP Infectious Diseases Pharmacy Specialist Phoebe Putney Memorial Hospital Adjunct Clinical Assistant Professor UGA College
More informationanidulafungin 100mg powder and solvent for concentrate for solution for infusion (Ecalta ) No. (465/08) Pfizer Ltd
Scottish Medicines Consortium Re-Submission anidulafungin 100mg powder and solvent for concentrate for solution for infusion (Ecalta ) No. (465/08) Pfizer Ltd 10 October 2008 The Scottish Medicines Consortium
More informationManagement and diagnostic guidelines for fungal diseases in infectious diseases and clinical microbiology: critical appraisal
REVIEW 10.1111/1469-0691.12426 Management and diagnostic guidelines for fungal diseases in infectious diseases and clinical microbiology: critical appraisal S. Leroux and A. J. Ullmann Department of Internal
More informationAntifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences
5th MMTN Conference 5-6 November 2016 Bangkok, Thailand 10:20-10:45, 6 Nov, 2016 Antifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences Yee-Chun Chen, M.D., PhD. Department of Medicine,
More informationFungal infections. Ematologia. Corrado Girmenia. Ematologia, Azienda Policlinico Umberto I Sapienza University of Rome, Italy
Fungal infections Corrado Girmenia Ematologia, Azienda Policlinico Umberto I Sapienza University of Rome, Italy Ematologia Epidemiology Diagnostic approach Prevention strategies Monitoring of IFDs in
More informationIs pre-emptive therapy a realistic approach?
Is pre-emptive therapy a realistic approach? J Peter Donnelly PhD, FRCPath Department of Haematology Radboud University Nijmegen Medical Centre Nijmegen, The Netherlands Is pre-emptive therapy a realistic
More informationMicafungin and Candida spp. Rationale for the EUCAST clinical breakpoints. Version February 2013
Micafungin and Candida spp. Rationale for the EUCAST clinical breakpoints. Version 1.0 5 February 2013 Foreword EUCAST The European Committee on Antimicrobial Susceptibility Testing (EUCAST) is organised
More informationAmphotericin B lipid complex: treatment of invasive fungal infections in patients refractory to or intolerant of amphotericin B deoxycholate
REVIEW Amphotericin B lipid complex: treatment of invasive fungal infections in patients refractory to or intolerant of amphotericin B deoxycholate PH Chandrasekar Division of Infectious Diseases, Department
More informationAspergillosis in the critically ill patient
Aspergillosis in the critically ill patient José Artur Paiva Director of Emergency and Intensive Care Department Centro Hospitalar São João Porto Associate Professor of Medicine University of Porto Infection
More informationInvazinės kandidozės, aspergiliozės ir mukormikozės ECIL-6 gydymo gairės, skirtos KKLT ir leukemija sergantiems pacientams Roberta Petrauskaitė
Invazinės kandidozės, aspergiliozės ir mukormikozės ECIL-6 gydymo gairės, skirtos KKLT ir leukemija sergantiems pacientams Roberta Petrauskaitė Wednesday, April 19, 2017 Planas Candida ir aspergillus infekcijų
More information