Re: Invasive aspergillosis survival, Voriconazole may be better than Amphotericin B

[Guest guest]

Is that what the poor " Man Without a Face " had?

For years I had what felt like an infection in my sinuses and in the orbits

of my eyes (no, I'm not immuno-compromised, just living in a moldy home) but

it might have just been my eyes reacting to the toxins that got picked up by

my (moist) eyes and rotated back when my eyes moved, not an actual invasive

mycoses.. It seems to have gone away now,except for a little very breifly a

few weeks ago.

Ive been taking all sorts of vitamins, etc. Dont know if that would help,

but it seems to a little.. (might be placebo effect)

On 11/20/05, tigerpaw2c <tigerpaw2c@...> wrote:

>

> Invasive aspergillosis survival, Voriconazole may be better than

> Amphotericin B

>

> http://www.xagena.it/news/medicinenews_net_news/6a9edcb7b63821802aa44

> d35d531c9fc.html

>

> The retrospective analysis, published in the Clinical Infectious

> Diseases, showed that patients who initially received antifungal

> agent Vfend ( Voriconazole ) were more likely to survive than

> patients who initially received Amphotericin B deoxycholate. The

> analysis also showed that patients who started on Vfend were less

> likely to need salvage therapy than those on Amphotericin B.

>

> Salvage therapy is treatment given after the infection has not

> responded to the initial treatment or if the patient cannot tolerate

> the initial medicine.

>

> Invasive aspergillosis is a severe pulmonary infection that can

> occur in patients with weakened immune systems. The fatality rate

> for invasive aspergillosis is estimated to be 58 percent, but

> approaches 90 to 100 percent in patients whose infection has spread

> beyond the primary site.

>

> " These high mortality rates for invasive aspergillosis underscore

> the importance of initial treatment for this often fatal infection, "

> said F. , lead author of the analysis and at the

> University of Texas Health Science Center at San . " Our

> analysis demonstrates that Voriconazole's efficacy and tolerability

> make it an important choice for first-line therapy. "

>

> The Global Comparative Aspergillosis Study ( GCAS ) led to Vfend's

> 2002 approval for the first-line treatment of invasive aspergillosis

> and was the basis for this newly published analysis.

> In that study, 144 patients with confirmed or probable invasive

> aspergillosis were started on Vfend and 133 were started on

> Amphotericin B. If the disease progressed or the patient was unable

> to tolerate initial therapy, treatment could be changed to salvage

> therapy, which was referred to in the trial as " other licensed

> antifungal therapy, " or OLAT.

>

> Treatment was considered successful if the infection improved or was

> cured after 12 weeks of total therapy. Therapies that were used as

> salvage therapy included lipid formulations of Amphotericin B,

> Itraconazole, a dose reduction in Amphotericin B, and other systemic

> antifungal therapy.

>

> et al retrospectively analyzed the data from the GCAS to

> assess the effect of salvage therapy on patient outcomes. Their

> analysis showed that just over a third ( 36 percent ) of patients in

> the Vfend group required subsequent salvage therapy, while more than

> three-quarters ( 80 percent ) of patients in the Amphotericin B

> group required salvage therapy.

>

> In addition, it found that of those patients in either group who had

> to switch to salvage therapy, patients who started on Vfend had

> better outcomes.

>

> Patients in the Vfend group, who were switched to OLAT, were more

> likely to survive than those in the Amphotericin B group who took

> OLAT ( 48 percent versus 38 percent, respectively ).

> Overall survival in the GCAS was 71 percent in the Vfend group

> versus 58 percent in the Amphotericin B group.

>

> Of patients who had to switch to OLAT due to drug intolerance, those

> treated initially with Vfend had a higher success rate than those in

> the Amphotericin B group ( 50 percent versus 38 percent,

> respectively ) .

>

> Of those who had to switch to OLAT due to their initial treatment

> not working for them, patients initially treated with Vfend had a

> higher success rate than those treated with Amphotericin B group (

> 26 percent versus 19 percent, respectively ).

>

> In addition, 55 percent of patients treated with Vfend alone had a

> successful outcome, compared to four percent of those on

> Amphotericin B alone.

> The overall efficacy rate was 53 percent for patients initially

> treated with Vfend, versus 32 percent for patients initially treated

> with Amphotericin B, regardless of whether OLAT was used.

>

> It should be noted that lipid formulations of Amphotericin B are

> often used due to their perceived reduction in toxicity. In the

> GCAS, the lipid formulations were the most commonly used OLAT ( 38

> percent of patients who received OLAT ).

>

> However, the subsequent analysis of that study demonstrated that

> this salvage therapy was effective in only 30 percent of patients in

> the Amphotericin B group and 36 percent of patients in the Vfend

> group.

> This success rate decreased to 12 percent when lipid formulations of

> Amphotericin B were used in patients following an initial

> insufficient clinical response to Amphotericin B deoxycholate.

>

> " Our analysis concluded that in order to reduce mortality rates

> associated with invasive aspergillosis, we need to rethink the

> practice of relying on salvage therapy, including lipid formulations

> of Amphotericin B, and focus more on making the right initial

> treatment decision, " said .

>

> Vfend is currently approved in the United States for the treatment

> of invasive aspergillosis, esophageal candidiasis, candidemia in

> nonneutropenic patients and certain Candida infections. Vfend is

> also approved as salvage therapy for fungal infections caused by

> pathogens Scedosporium apiospermum and Fusarium species.

>

> Vfend is the only IV/oral antifungal specifically indicated for the

> first-line treatment of mould and yeast infections.

>

> Most frequently reported adverse events in therapeutic trials were

> visual disturbances, fever, rash, vomiting, nausea, diarrhea,

> headache, sepsis, peripheral edema, abdominal pain and respiratory

> disorder.

> Treatment-related adverse events that most often led to

> discontinuation in clinical trials were elevated liver function

> tests ( LFTs ), rash and visual disturbances.

> Vfend treatment-related visual disturbances are common. The effect

> of Vfend on visual function is not known if treatment continues

> beyond 28 days.

>

> Vfend is contraindicated with Terfenadine, Astemizole, Cisapride,

> Pimozide, Quinidine ( since increased plasma concentrations for

> these drugs can lead to QT prolongation and rare occurrences of

> torsades de pointes ), Sirolimus, Rifampin, Rifabutin,

> Carbamazepine, long-acting barbiturates, ergot alkaloids, Efavirenz

> and Ritonavir ( 400 mg q12h ).

>

> There have been uncommon cases of serious hepatic reactions during

> treatment with Vfend ( clinical hepatitis, cholestasis and fulminant

> hepatic failure, including fatalities ). LFTs should be evaluated at

> the start of and during the course of therapy. Patients have rarely

> developed serious cutaneous reactions, such as s-

> syndrome, during treatment with Vfend.

>

> Source: Clinical Infectious Diseases, 2005

>

>

> XagenaMedicine2005

>

>

>

[Guest guest]

No, Mark Tatum had mucormycosis. From what I understand once this

gets into the sinus's it moves very rapidly. A high percentage of

the time it is not diagnosed until autopsy. Mark passed away this

past February, shortly after I had spoken to him. We had been

speaking to each other for about 2 years every weekend. The family

was supposed to get back with me on the cause, but never have. That

morning when I spoke to Mark he was doing excellant, feeling great

and it's probably the best I've heard him in 2 years. Hopefully I'll

hear from the family soon.

KC

> >

> > Invasive aspergillosis survival, Voriconazole may be better than

> > Amphotericin B

> >

> >

http://www.xagena.it/news/medicinenews_net_news/6a9edcb7b63821802aa44

> > d35d531c9fc.html

> >

> > The retrospective analysis, published in the Clinical Infectious

> > Diseases, showed that patients who initially received antifungal

> > agent Vfend ( Voriconazole ) were more likely to survive than

> > patients who initially received Amphotericin B deoxycholate. The

> > analysis also showed that patients who started on Vfend were less

> > likely to need salvage therapy than those on Amphotericin B.

> >

> > Salvage therapy is treatment given after the infection has not

> > responded to the initial treatment or if the patient cannot

tolerate

> > the initial medicine.

> >

> > Invasive aspergillosis is a severe pulmonary infection that can

> > occur in patients with weakened immune systems. The fatality rate

> > for invasive aspergillosis is estimated to be 58 percent, but

> > approaches 90 to 100 percent in patients whose infection has

spread

> > beyond the primary site.

> >

> > " These high mortality rates for invasive aspergillosis

underscore

> > the importance of initial treatment for this often fatal

infection, "

> > said F. , lead author of the analysis and at the

> > University of Texas Health Science Center at San . " Our

> > analysis demonstrates that Voriconazole's efficacy and

tolerability

> > make it an important choice for first-line therapy. "

> >

> > The Global Comparative Aspergillosis Study ( GCAS ) led to

Vfend's

> > 2002 approval for the first-line treatment of invasive

aspergillosis

> > and was the basis for this newly published analysis.

> > In that study, 144 patients with confirmed or probable invasive

> > aspergillosis were started on Vfend and 133 were started on

> > Amphotericin B. If the disease progressed or the patient was

unable

> > to tolerate initial therapy, treatment could be changed to

salvage

> > therapy, which was referred to in the trial as " other licensed

> > antifungal therapy, " or OLAT.

> >

> > Treatment was considered successful if the infection improved or

was

> > cured after 12 weeks of total therapy. Therapies that were used

as

> > salvage therapy included lipid formulations of Amphotericin B,

> > Itraconazole, a dose reduction in Amphotericin B, and other

systemic

> > antifungal therapy.

> >

> > et al retrospectively analyzed the data from the GCAS

to

> > assess the effect of salvage therapy on patient outcomes. Their

> > analysis showed that just over a third ( 36 percent ) of

patients in

> > the Vfend group required subsequent salvage therapy, while more

than

> > three-quarters ( 80 percent ) of patients in the Amphotericin B

> > group required salvage therapy.

> >

> > In addition, it found that of those patients in either group who

had

> > to switch to salvage therapy, patients who started on Vfend had

> > better outcomes.

> >

> > Patients in the Vfend group, who were switched to OLAT, were more

> > likely to survive than those in the Amphotericin B group who took

> > OLAT ( 48 percent versus 38 percent, respectively ).

> > Overall survival in the GCAS was 71 percent in the Vfend group

> > versus 58 percent in the Amphotericin B group.

> >

> > Of patients who had to switch to OLAT due to drug intolerance,

those

> > treated initially with Vfend had a higher success rate than

those in

> > the Amphotericin B group ( 50 percent versus 38 percent,

> > respectively ) .

> >

> > Of those who had to switch to OLAT due to their initial treatment

> > not working for them, patients initially treated with Vfend had a

> > higher success rate than those treated with Amphotericin B group

(

> > 26 percent versus 19 percent, respectively ).

> >

> > In addition, 55 percent of patients treated with Vfend alone had

a

> > successful outcome, compared to four percent of those on

> > Amphotericin B alone.

> > The overall efficacy rate was 53 percent for patients initially

> > treated with Vfend, versus 32 percent for patients initially

treated

> > with Amphotericin B, regardless of whether OLAT was used.

> >

> > It should be noted that lipid formulations of Amphotericin B are

> > often used due to their perceived reduction in toxicity. In the

> > GCAS, the lipid formulations were the most commonly used OLAT (

38

> > percent of patients who received OLAT ).

> >

> > However, the subsequent analysis of that study demonstrated that

> > this salvage therapy was effective in only 30 percent of

patients in

> > the Amphotericin B group and 36 percent of patients in the Vfend

> > group.

> > This success rate decreased to 12 percent when lipid

formulations of

> > Amphotericin B were used in patients following an initial

> > insufficient clinical response to Amphotericin B deoxycholate.

> >

> > " Our analysis concluded that in order to reduce mortality rates

> > associated with invasive aspergillosis, we need to rethink the

> > practice of relying on salvage therapy, including lipid

formulations

> > of Amphotericin B, and focus more on making the right initial

> > treatment decision, " said .

> >

> > Vfend is currently approved in the United States for the

treatment

> > of invasive aspergillosis, esophageal candidiasis, candidemia in

> > nonneutropenic patients and certain Candida infections. Vfend is

> > also approved as salvage therapy for fungal infections caused by

> > pathogens Scedosporium apiospermum and Fusarium species.

> >

> > Vfend is the only IV/oral antifungal specifically indicated for

the

> > first-line treatment of mould and yeast infections.

> >

> > Most frequently reported adverse events in therapeutic trials

were

> > visual disturbances, fever, rash, vomiting, nausea, diarrhea,

> > headache, sepsis, peripheral edema, abdominal pain and

respiratory

> > disorder.

> > Treatment-related adverse events that most often led to

> > discontinuation in clinical trials were elevated liver function

> > tests ( LFTs ), rash and visual disturbances.

> > Vfend treatment-related visual disturbances are common. The

effect

> > of Vfend on visual function is not known if treatment continues

> > beyond 28 days.

> >

> > Vfend is contraindicated with Terfenadine, Astemizole, Cisapride,

> > Pimozide, Quinidine ( since increased plasma concentrations for

> > these drugs can lead to QT prolongation and rare occurrences of

> > torsades de pointes ), Sirolimus, Rifampin, Rifabutin,

> > Carbamazepine, long-acting barbiturates, ergot alkaloids,

Efavirenz

> > and Ritonavir ( 400 mg q12h ).

> >

> > There have been uncommon cases of serious hepatic reactions

during

> > treatment with Vfend ( clinical hepatitis, cholestasis and

fulminant

> > hepatic failure, including fatalities ). LFTs should be

evaluated at

> > the start of and during the course of therapy. Patients have

rarely

> > developed serious cutaneous reactions, such as s-

> > syndrome, during treatment with Vfend.

> >

> > Source: Clinical Infectious Diseases, 2005

> >

> >

> > XagenaMedicine2005

> >

> >

> >

>

>

>

[Guest guest]

OF Course it works, better, it is an azole! It works on fungus infections. Duh.

>

> Invasive aspergillosis survival, Voriconazole may be better than

> Amphotericin B

>

> http://www.xagena.it/news/medicinenews_net_news/6a9edcb7b63821802aa44

> d35d531c9fc.html

>

> The retrospective analysis, published in the Clinical Infectious

> Diseases, showed that patients who initially received antifungal

> agent Vfend ( Voriconazole ) were more likely to survive than

> patients who initially received Amphotericin B deoxycholate. The

> analysis also showed that patients who started on Vfend were less

> likely to need salvage therapy than those on Amphotericin B.

>

> Salvage therapy is treatment given after the infection has not

> responded to the initial treatment or if the patient cannot tolerate

> the initial medicine.

>

> Invasive aspergillosis is a severe pulmonary infection that can

> occur in patients with weakened immune systems. The fatality rate

> for invasive aspergillosis is estimated to be 58 percent, but

> approaches 90 to 100 percent in patients whose infection has spread

> beyond the primary site.

>

> " These high mortality rates for invasive aspergillosis underscore

> the importance of initial treatment for this often fatal infection, "

> said F. , lead author of the analysis and at the

> University of Texas Health Science Center at San . " Our

> analysis demonstrates that Voriconazole's efficacy and tolerability

> make it an important choice for first-line therapy. "

>

> The Global Comparative Aspergillosis Study ( GCAS ) led to Vfend's

> 2002 approval for the first-line treatment of invasive aspergillosis

> and was the basis for this newly published analysis.

> In that study, 144 patients with confirmed or probable invasive

> aspergillosis were started on Vfend and 133 were started on

> Amphotericin B. If the disease progressed or the patient was unable

> to tolerate initial therapy, treatment could be changed to salvage

> therapy, which was referred to in the trial as " other licensed

> antifungal therapy, " or OLAT.

>

> Treatment was considered successful if the infection improved or was

> cured after 12 weeks of total therapy. Therapies that were used as

> salvage therapy included lipid formulations of Amphotericin B,

> Itraconazole, a dose reduction in Amphotericin B, and other systemic

> antifungal therapy.

>

> et al retrospectively analyzed the data from the GCAS to

> assess the effect of salvage therapy on patient outcomes. Their

> analysis showed that just over a third ( 36 percent ) of patients in

> the Vfend group required subsequent salvage therapy, while more than

> three-quarters ( 80 percent ) of patients in the Amphotericin B

> group required salvage therapy.

>

> In addition, it found that of those patients in either group who had

> to switch to salvage therapy, patients who started on Vfend had

> better outcomes.

>

> Patients in the Vfend group, who were switched to OLAT, were more

> likely to survive than those in the Amphotericin B group who took

> OLAT ( 48 percent versus 38 percent, respectively ).

> Overall survival in the GCAS was 71 percent in the Vfend group

> versus 58 percent in the Amphotericin B group.

>

> Of patients who had to switch to OLAT due to drug intolerance, those

> treated initially with Vfend had a higher success rate than those in

> the Amphotericin B group ( 50 percent versus 38 percent,

> respectively ) .

>

> Of those who had to switch to OLAT due to their initial treatment

> not working for them, patients initially treated with Vfend had a

> higher success rate than those treated with Amphotericin B group (

> 26 percent versus 19 percent, respectively ).

>

> In addition, 55 percent of patients treated with Vfend alone had a

> successful outcome, compared to four percent of those on

> Amphotericin B alone.

> The overall efficacy rate was 53 percent for patients initially

> treated with Vfend, versus 32 percent for patients initially treated

> with Amphotericin B, regardless of whether OLAT was used.

>

> It should be noted that lipid formulations of Amphotericin B are

> often used due to their perceived reduction in toxicity. In the

> GCAS, the lipid formulations were the most commonly used OLAT ( 38

> percent of patients who received OLAT ).

>

> However, the subsequent analysis of that study demonstrated that

> this salvage therapy was effective in only 30 percent of patients in

> the Amphotericin B group and 36 percent of patients in the Vfend

> group.

> This success rate decreased to 12 percent when lipid formulations of

> Amphotericin B were used in patients following an initial

> insufficient clinical response to Amphotericin B deoxycholate.

>

> " Our analysis concluded that in order to reduce mortality rates

> associated with invasive aspergillosis, we need to rethink the

> practice of relying on salvage therapy, including lipid formulations

> of Amphotericin B, and focus more on making the right initial

> treatment decision, " said .

>

> Vfend is currently approved in the United States for the treatment

> of invasive aspergillosis, esophageal candidiasis, candidemia in

> nonneutropenic patients and certain Candida infections. Vfend is

> also approved as salvage therapy for fungal infections caused by

> pathogens Scedosporium apiospermum and Fusarium species.

>

> Vfend is the only IV/oral antifungal specifically indicated for the

> first-line treatment of mould and yeast infections.

>

> Most frequently reported adverse events in therapeutic trials were

> visual disturbances, fever, rash, vomiting, nausea, diarrhea,

> headache, sepsis, peripheral edema, abdominal pain and respiratory

> disorder.

> Treatment-related adverse events that most often led to

> discontinuation in clinical trials were elevated liver function

> tests ( LFTs ), rash and visual disturbances.

> Vfend treatment-related visual disturbances are common. The effect

> of Vfend on visual function is not known if treatment continues

> beyond 28 days.

>

> Vfend is contraindicated with Terfenadine, Astemizole, Cisapride,

> Pimozide, Quinidine ( since increased plasma concentrations for

> these drugs can lead to QT prolongation and rare occurrences of

> torsades de pointes ), Sirolimus, Rifampin, Rifabutin,

> Carbamazepine, long-acting barbiturates, ergot alkaloids, Efavirenz

> and Ritonavir ( 400 mg q12h ).

>

> There have been uncommon cases of serious hepatic reactions during

> treatment with Vfend ( clinical hepatitis, cholestasis and fulminant

> hepatic failure, including fatalities ). LFTs should be evaluated at

> the start of and during the course of therapy. Patients have rarely

> developed serious cutaneous reactions, such as s-

> syndrome, during treatment with Vfend.

>

> Source: Clinical Infectious Diseases, 2005

>

>

> XagenaMedicine2005

>

[Guest guest]

<kl_clayton@y...> wrote:

>

> OF Course it works, better, it is an azole! It works on fungus

infections. Duh.

>

Not just a little - it's MUCH better.

Voriconazole is different from other triazoles and works especially

well on filamentous fungi expressed by fungal dimorphism.

Vfend has additional effects above cytochrome CP450 inhibition of

fungal cell wall formation which makes it more effective against

azole resistant strains such as C. Krusei and C. Tropicalis.

I spoke with Dr ph Heitman and Dr Perfect at Duke U. in

2001 when Vfend was in phase three trials and they were ecstatic

about the improvement over other azoles.

Dr Heitman said it worked as well as Amphotericin B without the

liver toxicity. He described the major side effect as a visible

epithelial photosensitivity reaction which made 'Vfenders' bright

red if they were exposed to sunlight, even if they get too near a

window. " You can spot 'em a mile away " .

I tried to interest Dr M in researching Vfend, which I think has

far greater potential that Sporonox, but last I heard, Dr M was

still relying on Sporonox and Lamisil.

-