Antifungal Therapies in 2003: where do we go?
(focusing invasive aspergillosis)

Séminaire de Pathologie Infectieuse (UCL) - 27/11/2003

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Table of Contents

Antifungal Therapies in 2003:where do we go?(focusing invasive aspergillosis)

Roadmap for This Talk

Invasive aspergillosis mortality:Review of literature after 1995

Can we prevent (or reduce the complications of) IFI by early interventions?

Number of patients vs. likelihood of disease

Fluconazole Prophylaxis

What are the major fungal pathogens in high-risk patients?

Itraconazole versus FluconazoleWinston et al. Ann Intern Med 2003; 138: 705Marr et al. Blood 2003 (Oct )

Not all hematology patients have the same risk:Targeted approaches?

TARGETED PROPHYLAXIS IN LIVER TRANSPLANT RECIPIENTS REQUIRING DIALYSIS Singh et al. Transplantation 2001; 71: 910

Reliability of the Halo SignGreene et al. 13th ECCMID Glasgow 2003; Abstr. O397

Can GM detection be used as a surrogate marker for early (preemptive) therapy ?

Molecular Approaches by PCR (blood)

Molecular Approaches by PCR (blood)

Amphotericin B in invasive aspergillosis:End of therapy responses

Clinical significance of nephrotoxicityWingard et al. CID 1999; 29: 1402

Response rates, overall survival rates, and toxicities associated with lipid formulations of amphotericin B as first-Iine therapy for invasive fungal infections, relative to conventional amphotericin B therapy, according to published randomized trials.

The New Broad-Spectrum Azoles

What makes the new azoles special?

What makes the new azoles special?

What makes the new azoles special?

What remains problematic?Drug Interactions and Pharmacokinetics (PK)

Vori MIC follows Flu MIC

Vori for Refractory Candidiasis

Voriconazole summary

The ‘Unmet’ Need

Spectrum of Activity

Pharmacokinetics and Metabolism

Safety and Interactions

ECHINOCANDINSClinical Development Programs

ECHINOCANDINSClinical Development Programs

Efficacy outcome at the end of caspofungin therapy

Invasive Candida: Overall Efficacy Results

Drug-related Laboratory Adverse Experiences (Candida)

Echinocandins and biofilms

Micafungin and CandidaemiaOstrosky-Zeichner et al. 13th Focus on Fungal Infections

Conclusions:Things we know about candins

Conclusions:Some things we need more info

The Hot TopicEchinocandins in Combination?

Caspofungin plus Voriconazole: animal model Kirkpatrick WR et al.: AAC 2002, 46: 2564-68

Micafungin +/- ampho B +/- azole in refractory aspergillosis in BMT recipientsRatanatharathorn et al, ASH 2002, # 2472

Author: Johan A. Maertens

Email: seminf@facm.ucl.ac.be

Home Page: http://www.md.ucl.ac.be/seminfect/resume.htm

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